Lidocaine Pharmacokinetics in Children during General Anesthesia

Finholt, David A.; Stirt, Joseph A.; DiFazio, Cosmo A.; Moscicki, Jeffrey C.

doi:10.1213/00000539-198603000-00010

Cited by 25 publications

(21 citation statements)

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“…The most prominent was lightheadedness that resolved promptly within 5–10 min. Although we did not measure plasma concentrations after injection of IV lidocaine we expect that the mean peak plasma level in our patients would be comparable to that observed after IV lidocaine 1 mg/kg administered in anesthetized children 33. Such a plasma level when sustained for 10–20 min by lidocaine infusion in awake adults with neuropathic pain is shown to produce side effects similar to those seen in our patients 11,32…”

Section: Discussionsupporting

confidence: 66%

Lumbar Sympathetic Blockade in Children with Complex Regional Pain Syndromes

Meier¹,

Zurakowski²,

Berde³

et al. 2009

Anesthesiology

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Background Sympathetic blockade is used in the management of complex regional pain syndromes in children but there are no data on the efficacy or mechanism(s) by which it produces pain relief. The purpose of this study is to compare the efficacy of lidocaine administered by lumbar sympathetic to intravenous route. Methods Under general anesthesia, children with unilateral lower limb complex regional pain syndromes received catheters along the lumbar sympathetic chain. In a double blind placebo-controlled crossover design, patients received intravenous lidocaine and lumbar sympathetic saline, or lumbar sympathetic lidocaine and intravenous saline. Spontaneous and evoked pain ratings and sensory thresholds were assessed before and after these two lidocaine/saline doses and between routes of lumbar sympathetic blockade and intravenous. Results Twenty-three patients, ages 10–18 years, were enrolled. There was evidence for reduction of mean pain intensity of allodynia to brush (mean −1.4, 95% CI −2.5, −0.3) and to pinprick temporal summation (mean −1.3, 95% CI −2.5, −0.2) with lidocaine treatment via the lumbar sympathetic blockade compared to intravenous route. Lumbar sympathetic blockade also produced significant reduction in pain intensity compared to pretreatment values of allodynia to brush, pinprick and pinprick temporal summation and verbal pain scores. Intravenous lidocaine did not produce significant changes in spontaneous and evoked pain intensity measurements compared to pretreatment values. There were no carry-over effects as assessed by route-by-period interaction. Conclusions Under the conditions of this study, the results provide some direct evidence that a component of pain may be mediated by abnormal sympathetic efferent activity.

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Section: Discussionsupporting

confidence: 66%

Lumbar Sympathetic Blockade in Children with Complex Regional Pain Syndromes

Meier¹,

Zurakowski²,

Berde³

et al. 2009

Anesthesiology

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“…[223,230] It must be emphasized that almost all studies comparing bupivacaine racemate and ropivacaine or levobupivacaine have used local anesthetic concentrations much greater than those required for effective caudal epidural analgesia in infants and children. As these higher concentrations are far in excess of the documented or putative ED 50 values of the three local anesthetics, the presumed anesthetic equivalence of bupivacaine racemate, ropivacaine and levobupivacaine may simply be a result of using all three local anesthetics at concentrations which are, to a greater or lesser degree, in excess of the ED 95 . It is therefore inappropriate to extend the accepted local anesthetic equivalence of 0.2 or 0.25% bupivacaine racemate and ropivacaine in children or of 0.5% bupivacaine racemate and levobupivacaine in adults, to the lower concentrations sometimes used in infants and children.…”

Section: Levobupivacainementioning

confidence: 99%

“…[93] In general, C max , time to C max (t max ), volume of distribution at steady state (Vd ss ), clearance and half-life (t 1 ⁄2 ) values in children have been comparable to the values seen in adults, although the Vd ss and t 1 ⁄2 , but not the clearance, values reported for children by Ecoffey et al [94] were greater than the corresponding values for adults. [77,95] Although lidocaine has a generally favorable toxicity profile, its use for spinal anesthesia has been associated with transient neurologic symptoms (TNS). First described in 1993, [99] TNS present as radicular back pain after resolution of spinal anesthesia without associated sensory or motor neurologic deficits.…”

Section: Lidocaine (Lignocaine)mentioning

confidence: 99%

Benefit and Risks of Local Anesthetics in Infants and Children

Gunter

2002

Pediatric Drugs

155

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Regional anesthesia has become a routine part of the practice of anesthesiology in infants and children. Local anesthetic toxicity is extremely rare in infants and children; however, seizures, dysrhythmias, cardiovascular collapse, and transient neuropathic symptoms have been reported. Infants and children may be at increased risk from local anesthetics compared with adults. Larger volumes of local anesthetics are used for epidural anesthesia in infants and children than in adults. Metabolism and elimination of local anesthetics can be delayed in neonates, who also have decreased plasma concentrations of alpha(1)-acid glycoprotein, leading to increased concentrations of unbound bupivacaine. Most regional anesthetic procedures in infants and children are performed with the patient heavily sedated or anesthetized; because of this, and because a test dose is not a particularly sensitive marker of intravenous injection in the anesthetized patient, detection of intravascular local anesthetic injection is extremely difficult. The same local anesthetics used in adult anesthetic practice are also used in infants and children. Because of its extremely short duration of action, chloroprocaine has been used primarily for continuous epidural techniques in infants and children. The use of tetracaine has generally been limited to spinal and topical anesthesia. Lidocaine (lignocaine) has been used extensively in infants and children for topical, regional, plexus, epidural and spinal anesthesia. The association between prilocaine and methemoglobinemia has generally restricted prilocaine use in infants and children to the eutectic mixture of local anesthetics (EMLA). Because of its greater degree of motor block compared with other long-acting local anesthetics, etidocaine has generally been limited to plexus blocks in infants and children. Mepivacaine has been used for both plexus and epidural anesthesia in infants and children. Because postoperative analgesia is often the primary justification for regional anesthesia in infants and children, bupivacaine, a long-acting local anesthetic, is the most commonly reported local anesthetic for pediatric regional anesthesia. Given the lower toxic threshold of bupivacaine compared with other local anesthetics, the risk-benefit ratio of bupivacaine may be greater than that of other local anesthetics. Two new enantiomerically pure local anesthetics, ropivacaine and levobupivacaine, offer clinical profiles comparable to that of bupivacaine but without its lower toxic threshold. The extreme rarity of major toxicity from local anesthetics suggests that widespread replacement of bupivacaine with ropivacaine or levobupivacaine is probably not necessary. However, there are clinical situations, including prolonged local anesthetic infusions, use in neonates, impaired hepatic metabolic function, and anesthetic techniques requiring a large mass of local anesthetic, where replacement of bupivacaine with ropivacaine, levobupivacaine or (for continuous techniques) chloroprocaine appears prudent.

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“…La toxicité de la lidocaïne se manifeste généralement d'abord par des signes neurologiques [2,6]. Il n'a pas été mis en évidence de différence concernant la pharmacocinétique de la lidocaïne administrée en intra-vasculaire chez l'adulte et chez l'enfant [7]. Le seuil sérique de toxicité est de 6 mg/L et la demi-vie d'élimination est de 1,5 à 2 heures.…”

Section: Discussionunclassified