Preliminary Experience With a Continuous Lidocaine Infusion as an Analgesia Adjunct for Acute Pain Management Following Surgery in Pediatric Patients

Background: Lidocaine is a local anesthetic of the amide class that has been used for various therapeutic interventions. Its potential analgesic effects have been reported in anecdotal reports and larger clinical trials. Methods: We retrospectively reviewed our 24-month experience with the use of lidocaine outside of the intensive care unit (ICU) setting as an adjunct to acute pain management following major surgical procedures in children and adolescents. Results: The study cohort included 168 patients (mean age 13.8 years). The majority of patients (N = 142) underwent a posterior spinal fusion for treatment of scoliosis (idiopathic or neuromuscular). Thirty-one patients received a bolus dose followed by an infusion starting at 0.2 to 2 mg/kg/h (average dose 0.97 mg/kg/h). Most patients (86.3%) received a continuous lidocaine infusion for 1 - 3 days at an average dose of 1 mg/kg/h. Lidocaine was infused for a total of 503 days in the study cohort of 168 patients. Despite that these were major surgical procedures, pain scores were generally acceptable. The lidocaine infusion was discontinued or decreased in eight patients due to concerns of adverse effects. Adverse effects were noted in 38 days of the 503 days of infusion (7.6%). A total of 29 patients (17.3%) experienced at least one adverse effect. The majority of these were related to the central nervous system (CNS) including blurred vision, dizziness, drowsiness/difficult to arouse, delirium, hallucinations, agitation, confusion, delirium, hallucinations, agitation, and confusion. Conclusions: We present the largest study to date outlining the use of lidocaine as an adjunct to acute pain management in children and adolescents. These preliminary data suggest that with enhanced clinical observation for signs of potential toxicity and increased clinical monitoring of vital signs, the lidocaine infusion can be administered on the inpatient ward without routine serum concentration monitoring. The current cohort and other studies in pediatric patients provide a background for prospective studies to evaluate dosing regimens, optimal patient populations, and analgesic efficacy. Int J Clin Pediatr. 2023;12(2):29-36 doi: https://doi.org/10.14740/ijcp522