Safety and Tolerability of Lidocaine Infusions as a Component of Multimodal Postoperative Analgesia in Children

Abstract

OBJECTIVES Use of lidocaine as part of a multimodal approach to postoperative pain management has increased in adults; however, limited information is available regarding safety and tolerability in pediatrics. This study's primary objective was to evaluate the incidence of adverse effects related to lidocaine infusions in a sample of pediatric patients. METHODS A retrospective analysis was conducted in pediatric patients receiving lidocaine infusion for the management of postoperative analgesia at the University of Virginia Health System. RESULTS A total of 50 patients with 51 infusions were included in the final analysis. The median patient age was 14 years (range, 2–17 years). The most frequent surgeries were spinal fusion (30%), Nuss procedure for pectus excavatum (16%), and nephrectomy (6%). The mean ± SD starting rate was 13.6 ± 6.5 mcg/kg/min. The mean infusion rate during administration was 15.2 ± 6.3 mcg/kg/min, with 14.4 ± 6.2 mcg/kg/min at discontinuation. The mean length of therapy was 30.6 ± 22 hours. A total of 12 infusions (24%) were associated with adverse effects, primarily neurologic ones, including paresthesias in the upper extremities (10%) and visual disturbances (4%). The average time to onset was 16.2 ± 15.2 hours. Seven infusions were discontinued, whereas the remaining infusions resulted in either dose reduction or continuation without further incident. No patients experienced toxicity requiring treatment with lipid emulsion. CONCLUSIONS In this sample, lidocaine was a well-tolerated addition to multimodal postoperative pain management in the pediatric population. Although adverse effects were common, they were mild and resolved with either dose reduction or discontinuation.

Electrocorticographic description of the effects of anticonvulsant drugs used to treat lidocaine‐induced seizures

“…The clinical use of LA as an anesthetic is a common and routine practice in medical and dental treatments (Lemming et al., 2019; Nagendrababu et al., 2019). However, there is a high rate of poisoning by LA, especially when it is not associated with a vasoconstrictor (usually adrenaline).…”

Intravenous lidocaine infusion for the treatment of acute pain in the pediatric intensive care unit: case series

“…All the cases documented in this report were collected in the PICU of the Military Hospital in Bogota, Colombia, between July 2019 and July 2020, and comprise patients with acute abdominal pain, distributed as follows: five postoperative cases and five non-surgical cases. Pain management was based on lidocaine infusion at a rate of 1 mg/kg/hour (8,9) for 24-48 hours, associated to the use of paracetamol 15 mg/kg. Li-docaine bolus administration was not used.…”

“…In infants under 6-7 months of age, liver metabolism is immature, plasma levels of acid glycoprotein α-1 are low, which increases free circulating lidocaine and, consequently, the risk of toxicity (4). Case studies described in pediatrics (8,9) have used lidocaine infusion at doses ranging between 0.5 and 2 mg/kg/hour, with varying results in terms of adverse effects. IVLT doses used for pain relief are usually in the range of 1 to 2 mg/kg/hour.…”

“…Consequently, it is considered to be a necessary drug in modern perioperative management. Notwithstanding the fact that data in adults are promising, there is a paucity of evidence supporting the use of lidocaine infusions in the pediatric population (5)(6)(7)(8)(9).…”

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

“…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 …”