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

Conclusions

In conclusion, intraoperative systemic lidocaine administration in the studied pattern reduced the intraoperative requirement for opioids in children undergoing laparoscopic appendectomy. This effect was time limited, and hence did not affect opioid consumption in the first 24 h following discontinuation of lidocaine infusion.

Study Limitations

Single-blinding is the main limitation of the study.

In the study team only three physicians were responsible for providing anesthesia. Only one of them was on duty at the hospital at any one time. He was responsible for participant recruitment, obtaining consent, providing anesthesia, and data collection. Due to the aforementioned circumstances, we concluded that the effort involved in double blinding would further complicate the protocol and might be a source of potential inadequacies in other fields. The measures taken to compensate for the lack of double blinding are described further in this section.

The patients were not informed about allocation. Due to their age and being under general anesthesia, they were obviously unable to consciously affect the measured parameters. The anesthesia team was blinded to group assignment until just before surgery, when the envelope was opened. While selection bias and response bias were prevented, the anesthetist might have, consciously or unconsciously, influenced opioid consumption. To minimize the effects of this bias, the following measures were employed:

  • The group of physicians responsible for anesthesia was narrow;

  • An explicit protocol of opioid administration was created;

  • The researchers strictly adhered to the protocol;

Another limitation is that the effect of intravenous lidocaine infusion on the neuroendocrine response to surgical trauma was not assessed using objective biochemical markers like blood levels of stress hormones and cytokines.

Due to technical limitations, the age-adjusted minimal alveolar concentration (MAC) of sevoflurane, however routinely utilized, was not analyzed. The lack of communication between the anesthetic gases and vapors monitor and the server meant that the data were unavailable for statistical testing. BIS values obtained by the cardiac monitor were continuously sent to the server and are available for further evaluation.

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