Continuous Incisional Lidocaine in Pediatric Patients following Open Heart Surgery.

Sarah Nicole Fernández,Santiago Mencía,Blanca Toledo,Jesús López-Herce,Ramón Pérez-Caballero,Jesús Cebrián,Cem Karadeniz

doi:10.1155/2022/1403539

Abstract

Continuous incisional lidocaine infusion has been proposed as an adjunctive therapy in the management of postoperative pain in adult patients. The aim of this study was to determine the efficacy and safety of a continuous subcutaneous lidocaine infusion in pediatric patients following open heart surgery. All patients receiving a subcutaneous lidocaine infusion in median sternotomy incisions after open heart surgery during 2 consecutive years were included in the study. A historical cohort of patients was used as a control group. Demographic variables (age, size, and surgical procedure), variables related to sedation and analgesia (COMFORT and analgesia scales, drug doses, and duration), and complications were registered. 106 patients in the lidocaine infusion group and 79 patients in the control group were included. Incisional analgesia was effective for the treatment of pain as it reduced the dose and duration of intravenous fentanyl (odds ratio (OR) 6.26, confidence interval (CI) 95%: 2.48-15.97, p = 0.001; OR 4.30, CI 95%: 2.09-8.84, p = 0.001, respectively). The reduction in fentanyl use was more important in children over two years of age. Adverse effects were seen in three children (2.8%): they all had decreased level of consciousness, and one of them presented seizures as well. Two of these three patients had lidocaine levels over 2 mcg/ml. A continuous lidocaine incisional infusion is effective for the treatment of pain after open heart surgery. This procedure reduced intravenous analgesic drug requirements in pediatric patients undergoing a median sternotomy incision. Although the incidence of secondary effects is low, monitoring of neurologic status and lidocaine blood levels are recommended in all patients.

Highlights

Appropriate analgesia after a surgical intervention is essential, especially after sternotomy in pediatric patients [1,2,3,4,5].Pain management in the postoperative period includes intravenous analgesic drugs such as opioids, nonsteroidal anti-inflammatory drugs, metamizole, and paracetamol [3, 4]
An observational prospective study was performed including all patients with an incisional lidocaine infusion in medial sternotomy after heart surgery admitted to a single Paediatric Intensive Care Unit (PICU) for two consecutive years
Results were compared with a historical control group of 79 patients without incisional analgesia admitted after heart surgery between the 1st of January 2011 and the 31st of December 2011

Summary

Introduction

Appropriate analgesia after a surgical intervention is essential, especially after sternotomy in pediatric patients [1,2,3,4,5].Pain management in the postoperative period includes intravenous analgesic drugs such as opioids, nonsteroidal anti-inflammatory drugs, metamizole, and paracetamol [3, 4]. Appropriate analgesia after a surgical intervention is essential, especially after sternotomy in pediatric patients [1,2,3,4,5]. Over the few last years, some authors have recommended a multimodal approach combining intravenous drugs with regional techniques such as epidural analgesia, nerve block, or continuous infusion of local anaesthesia into the surgical wound [2, 5,6,7,8,9,10] in order to improve analgesic efficacy and to decrease adverse effects [1,2,3, 11]. Several studies performed in adults show the efficacy of incisional analgesia to decrease postoperative pain in different kinds of surgeries, including. There is limited evidence about its use in pediatric patients [15,16,17]

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