Perioperative Intravenous Lidocaine Infusion Therapy as an Adjunct to Multimodal Analgesia for Adolescent Idiopathic Scoliosis Surgical Correction: A Double-Blind Randomized Controlled Trial.

Abstract

Background: Posterior spinal instrumentation and fusion is a common surgical correction for adolescent idiopathic scoliosis. Preventative multimodal analgesia, including opioids, is required to minimize postoperative pain, but opioids are associated with dose-dependent side effects that may disrupt recovery.

Aims: We hypothesized that the addition of 48-h perioperative intravenous lidocaine therapy to a multimodal analgesia regimen would reduce morphine utilization.

Method: We conducted a double-blinded randomized controlled trial in 10-19 years old, ASA I-III, undergoing single-stage scoliosis correction. Participants were randomly allocated to the Intervention group (intravenous lidocaine 1 mg kg^-1 bolus at anesthesia start, followed by 2 mg kg^-1 h^-1 infusion for 8 h, followed by 1 mg kg^-1 h^-1 for 40 h) or Control (normal saline). Participants received standardized perioperative multimodal analgesia, including a postoperative morphine infusion with titration rules protocolized to self-reported pain scores. The primary outcome was 48-h morphine utilization; secondary outcomes were median and worst pain scores, and times to first stand, first walk > 15 steps, urinary catheter removal, termination of morphine infusion, and hospital discharge.

Results: Data were available from 38 participants: 32 (84%) female; median (IQR) age 16.3 (14.9-17.2) years, with curve magnitude (Cobb angle) 62 (56-70) degrees. The 48-h morphine utilization did not differ between groups: Intervention median (IQR) 0.86 (0.73-1.05) mg kg^-1 versus Control 1.00 (0.77-1.18) mg kg^-1; median difference -0.11 (95% CI -0.30 to 0.13) mg kg^-1; p = 0.264. There were similarly no differences in morphine utilization at 12, 24, or 36 h or any secondary outcome, except the first postoperative pain score: Intervention 3/10 (1.75-5) versus Control 5/10 (3-7); median difference -2 (95% CI 0 to -3); p = 0.035. Three cases with mild symptoms of suspected local anesthetic systemic toxicity were observed in the Intervention group.

Conclusions: We found no evidence to support the adjunctive use of 48-h perioperative intravenous lidocaine therapy in adolescents undergoing scoliosis correction in which effective multimodal analgesia was adopted.

Trial registration: ClinicalTrials.gov identifier: NCT04069169.