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

Abstract

Background Despite a more robust experience with lidocaine infusions for pain management in adults and general pediatric population, there is limited evidence of efficacy of lidocaine infusions for pain management in patients with pediatric hematology and oncology diagnoses. Methods Data pertaining to continuous intravenous lidocaine infusions prescribed between January 2009 and June 2019 were reviewed, including patients’ demographic characteristics, hematology/oncology and pain diagnoses, concurrent pain medications, and lidocaine infusion dose regimens and duration. Pain scores and opioid consumption calculations based on morphine equivalent doses (mg/kg/day) of patient‐controlled analgesia were collected 1 day before infusion (D1), during infusion (D2), and 1 day after infusion (D3). Results The mean opioid consumption on D3 was significantly lower than that on D2 (p = .01). The pain scores on D3 were significantly lower than those on D1 when measured as average pain scores per 24 hours (p < .001) or as single pain scores immediately before and after infusions (p < .001). No significant associations were found between cumulative doses of lidocaine (loading dose plus total infusion dose) and either a decrease in the opioid consumption or a decrease in pain scores. Conclusions In this retrospective series of pediatric hematology and oncology cases, we report positive outcomes in reducing opioid consumption and pain scores after lidocaine infusions. Prospective investigations designed in a collaborative, multi‐institutional fashion, including a variety of pediatric populations are needed to further investigate the efficacy of lidocaine infusions.

Lidocaine and Ketamine Infusions as Adjunctive Pain Management Therapy: A Retrospective Analysis of Clinical Outcomes in Hospitalized Patients Admitted for Pain Related to Sickle Cell Disease

“…Reports on the efficacy of both lidocaine and ketamine infusions in adolescents with vaso-occlusive crisis have emerged recently ( 32 ). Similarly, lidocaine infusions have been shown to reduce opioid consumption in pediatric hematology and oncology patients with refractory pain ( 33 ).…”

“…When opioid dose escalation alone does not provide relief during painful crises, multimodal analgesia is required; therefore, every hospital that treats SCD should have such protocols for these events. While ketamine has been used before in VOC, lidocaine has been studied more on pediatric and adolescent patients with VOC (32)(33)(34). This retrospective study identifies intravenous lidocaine as a potential analgesic similar to IV ketamine to treat acute opioid dose escalations in painful unrelenting VOC; both agents seem to have the same analgesic and stabilizing effects on opioid doses.…”

Systemic Lidocaine Infusions for Pediatric Patients with Cancer-Related Pain

“…It is also thought to have anti-inflammatory properties in reducing circulating inflammatory cytokines, such as interleukin (IL)-6, IL-1β, and tumor necrosis factors [ 22 , 23 ]. At higher doses, lidocaine also acts on NMDA receptors and suppresses spontaneous impulses generated from injured nerve fibers, thereby downregulating pain transmission pathways, which may contribute to its ability to provide analgesia beyond the length of the infusion [ 21 , 24 ].…”

“…The practical application of intravenous lidocaine has been described in previous literature [ 24 , 25 ]. In the perioperative scenarios, anesthesiologists have supervised the initiation of intravenous lidocaine in a monitored environment, such as a post-anesthesia care unit (PACU) [ 25 ].…”

“…In the perioperative scenarios, anesthesiologists have supervised the initiation of intravenous lidocaine in a monitored environment, such as a post-anesthesia care unit (PACU) [ 25 ]. In the pediatric hematologic and oncologic settings, intravenous lidocaine has been initiated on the inpatient floor, with certain patients receiving subsequent infusions in the outpatient clinic setting [ 24 ]. For the initiation of systemic lidocaine infusions, it is recommended to perform neurologic assessments of the level of sedation and to have cardiopulmonary monitoring readily available per patient-controlled anesthesia standards [ 21 , 24 , 25 ].…”