Lidocaine as an element of multimodal analgesic therapy in major spine surgical procedures in children: a prospective, randomized, double-blind study

Abstract

Background Introducing the principles of multimodal analgesic therapy is necessary to provide appropriate comfort for the patient after surgery. The main objective of the study was evaluating the influence of perioperative intravenous (i.v.) lidocaine infusion on postoperative morphine requirements during the first 48 h postoperatively in children undergoing major spine surgery. Materials and methods Prospective, randomized, double-blind study: 41 children, qualified to multilevel spine surgery, were randomly divided into two treatment groups: lidocaine and placebo (control). The lidocaine group received lidocaine as a bolus of 1.5 mg/kg over 30 minutes, followed by a continuous infusion at 1 mg/kg/h to 6 hours after surgery. The protocol of perioperative management was identical for all patients. Measurements: morphine demand, intensity of postoperative pain (the Numerical Rating Scale), oral feeding initiation time, first attempts at assuming erect position, postoperative quality of life (the Acute Short-form /SF-12/ health survey). Results Patient data did not differ demographically. Compared to the control group, lidocaine treatment reduced the demand for morphine during the first 24h [95% CI 0.13 (0.11-0.28) mg/kg, p = 0.0122], 48h [95% CI 0.46 (0.22-0.52) mg/kg, p = 0.0299] after surgery and entire hospitalization [95% CI 0.58 (0.19-0.78) mg/kg, p = 0.04]; postoperative pain intensity; nutritional withdrawal period [introduction of liquid diet (p = 0.024) and solid diet (p = 0.012)], and accelerated the adoption of an upright position [sitting (p = 0.048); walking (p = 0.049)]. The SF-12 generic health survey did not differ between groups before operation, 2 months and 4 years after surgery. Conclusions Perioperative lidocaine administration, as a part of the applied analgesic therapy regimen, may decrease postoperative opioid demand and accelerates convalescence of children undergoing major surgery.

Lidocaine infusions and reduced opioid consumption—Retrospective experience in pediatric hematology and oncology patients with refractory pain

“…The practice of lidocaine bolus administration prior to the infusion contributes to this variability. As previously described in the literature, 7,8,23,28,30,31 and consistent with our institutional practice, a bolus may be administered prior to the lidocaine infusion to assess the patient's response and to establish a clinically effective lidocaine plasma level. In our practice, the decision to administer a bolus prior to the infusion is at the discretion of the pain management clinician and is based on patient‐specific considerations.…”

“…The most robust evidence supporting the effectiveness of lidocaine infusions for pain management is based on their use in the perioperative setting, both in adults 1–6 and in pediatrics 7–11 . Other applications for lidocaine infusions in adult pain management include chronic pain conditions, 12,13 neuropathic pain conditions, 14–18 chemotherapy‐induced neuropathic pain, 19,20 cancer pain, 21 and acute sickle cell disease‐related pain 22 …”

Pathway for Enhanced Recovery after Spinal Surgery-A Systematic Review of Evidence for use of Individual Components

“…In a number of controlled trials in both adult and pediatric major and minor spine surgery, perioperative lignocaine infusion was demonstrated to improve pain scores and decrease opioid consumption (217–220). Conversely, in a randomized controlled trial of seventy patients undergoing posterior spine surgery, there was no analgesic benefit of a systemic lignocaine infusion as compared to placebo (221).…”

Pathway for enhanced recovery after spinal surgery-a systematic review of evidence for use of individual components

“…Intravenous lignocaine In a number of controlled trials in both adult and pediatric major and minor spine surgery, perioperative lignocaine infusion was demonstrated to improve pain scores and decrease opioid consumption [218][219][220][221]. Conversely, in a randomized controlled trial of 70 patients undergoing posterior spine surgery, there was no analgesic benefit of a systemic lignocaine infusion as compared to placebo [222].…”