Abstract
BackgroundDue to its potential beneficial effects, intra- and postoperative application of intravenous lidocaine has become increasingly accepted over the last couple of years, e.g. in patients undergoing laparoscopic surgical procedures. Based on its beneficial properties, lidocaine was introduced to the standard of care for all pediatric laparoscopic procedures in our institution in mid-2016. In contrast to adult care, scarce data is available regarding the use of perioperative intravenous lidocaine administration in children undergoing laparoscopic procedures, such as an appendectomy.MethodsRetrospective analysis of all pediatric patients undergoing laparoscopic appendectomy at the University Children’s Hospital Zurich in 2016. Perioperative data, as recorded in the electronic patient data management system, were evaluated for any signs of systemic lidocaine toxicity (neurological and cardiovascular), behavioral deterioration, as well as for hemodynamic instability. Additionally, the incidence of postoperative nausea and vomiting, administration of pain rescue medication, time to hospital discharge and to first bowel movement, as well as any postoperative complications were recorded. Starting on 01/07/2016, all patients undergoing laparoscopic surgery received intravenous lidocaine (1.5 mg/kg body weight (BW) bolus after induction of anesthesia followed by continuous infusion of 1.5 mg/kgBW/h). These patients were then compared to children without lidocaine administration who had undergone laparoscopic appendectomy between 01/01/2016 and 30/06/2016.ResultsData of 116 patients was analyzed. Of these, 60 patients received lidocaine. No signs of systemic toxicity, neurologic impairment or circulatory disturbances were noted in any of these patients. A (non-significant) difference in the incidence of emergence delirium was observed (0 cases in the lidocaine group vs. 4 cases in the control group, p = 0.05).ConclusionThis retrospective analysis did not reveal any adverse effects in pediatric patients receiving intravenous lidocaine for laparoscopic appendectomy under general anesthesia. However, further trials investigating beneficial effects as well as pharmacokinetic properties of intravenous lidocaine in children are required.
Highlights
Due to its potential beneficial effects, intra- and postoperative application of intravenous lidocaine has become increasingly accepted over the last couple of years, e.g. in patients undergoing laparoscopic surgical procedures
A recent Cochrane analysis assessing 45 trials with 2802 mixed surgical patients found low to moderate evidence that intravenous lidocaine might be able to reduce early postoperative pain scores and postoperative nausea and vomiting (PONV), as well as some limited evidence for a beneficial effect on other postoperative parameters, such as post-operative opioid requirements, the length of hospital stay or the time to first bowel movement [14]
Based on its potential beneficial effects regarding postoperative pain control or postoperative nausea and vomiting (PONV), we introduced the additive perioperative administration of intravenous lidocaine to our standard anesthesia regimen for all laparoscopic procedures on July 1st, 2016
Summary
Due to its potential beneficial effects, intra- and postoperative application of intravenous lidocaine has become increasingly accepted over the last couple of years, e.g. in patients undergoing laparoscopic surgical procedures. In contrast to adult care, scarce data is available regarding the use of perioperative intravenous lidocaine administration in children undergoing laparoscopic procedures, such as an appendectomy. Several clinical trials have examined potential beneficial effects of perioperative intravenous lidocaine use due to its anti-inflammatory characteristics [5,6,7,8], e.g. in patients undergoing laparoscopic procedures [9,10,11,12,13]. Based on its potential beneficial effects regarding postoperative pain control or postoperative nausea and vomiting (PONV), we introduced the additive perioperative administration of intravenous lidocaine to our standard anesthesia regimen for all laparoscopic procedures on July 1st, 2016
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