Efficacy of Intravenous Lidocaine Infusions for Pain Relief in Children Undergoing Laparoscopic Appendectomy

A Randomized Controlled Trial

Maciej Kaszyński; Dorota Lewandowska; Piotr Sawicki; Piotr Wojcieszak; Izabela Pągowska-Klimek

Disclosures

BMC Anesthesiol. 2021;21(2) 

In This Article

Results

Study Population

Of the 86 patients who were screened, 1 patient did not meet the criteria (ECG abnormalities), 2 patients could not be enrolled due to the language barrier, while 9 patients refused participation. Patient recruitment was suspended from 6 May to 12 May 2019 due to the lack of nalbuphine in the surgery ward.

Seventy-four children met the eligibility criteria and were randomized between March 2019 and January 2020. Seventy-one participants completed the trial. Thirty-five were assigned to the lidocaine infusion group and 36 were assigned to the control group – without lidocaine infusion.

Three patients were excluded due to the conversion from laparoscopic to open surgery.

Baseline demographic and clinical characteristics are presented in Table 2.

Intraoperative Clinical Data and Perioperative Non-opioid Analgesics Consumption

The bispectral index, duration of surgery, duration of anesthesia, time to emerge from anesthesia did not differ between groups (Table 3).

Doses of Acetaminophen and Metamizole in the whole perioperative period were similar in both groups (Table 4).

Primary Outcome

Postoperative Opioid Consumption in the First 24 h After Removal of the Endotracheal Tube. Of the 71 patients, 51 required nalbuphine in the postoperative period: 27 from the lidocaine group and 30 from the control group. There was no difference in the cumulative dose of nalbuphine in the first 24 h after removal of the endotracheal tube between groups [median of 0.1061 (IQR: 0.0962–0.2222) mg/kg in the lidocaine group, compared to the control group median of 0.1325 (IQR: 0.0899–0.22020) mg/kg, p = 0.63].

Secondary Outcomes

The Requirement for Opioids During Anesthesia. According to the study protocol, doses of fentanyl administered before intubation and before skin incision were similar in both groups (Table 3).

The number of patients demanding additional doses of fentanyl was different in both groups: 11 (31.43%) in the lidocaine group and 24 (66.67%) in the control group, p = 0.003.

Patients in the lidocaine group required less fentanyl intraoperatively (median of 5.091 (IQR: 4.848–5.714) vs 5.969 (IQR: 5.000–6.748) μg/kg, p = 0.03).

Taking into account the additional doses administered based on clinical indications (when the heart rate or blood pressure exceeded 20% of baseline readings), the reduction in the requirement of fentanyl in the lidocaine group was even greater [median of 0.0 (IQR: 0.0–0.952) vs 0.99 (IQR: 0.0–1.809) μg/kg, p = 0.01].

The Consumption of Volatile Anesthetics. No difference in the sevoflurane consumption between the two groups was observed [median of 32.5 ml (IQR 25.0–43.0) in the lidocaine group vs median of 35.0 ml (IQR: 23.5–46.0) in the control group, p = 0.56] (Table 3).

Time to First Perception of Significant Pain. The time to first analgesic request in the lidocaine group was prolonged [median of 55 (IQR: 40–110) min in the lidocaine group vs median of 40.5 (IQR: 28–65) min in the control group, p = 0.05] (Table 4).

Incidence of Postoperative Nausea and Vomiting (PONV) in the First 24 h After Removal of the Endotracheal Tube. Thirty-nine of 71 participants suffered from nausea and vomiting: 17 (48.57%) in the lidocaine group and 22 (61.11%) in the control group, p = 0.28838.

The differences between groups in the duration of PONV and in the number of patients requiring the use of ondansetron was of no statistical importance (Table 5).

Side Effects of Lidocaine. No lidocaine related incidence of anaphylaxis, systemic toxicity, circulatory disturbances or neurological impairment was reported, during anesthesia or 24 h after removal of the endotracheal tube.

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