Division of Pediatric Critical Care Medicine, Department of Pediatrics, Fountain Valley Regional Hospital and Medical Center, Fountain Valley, CA.
Department of Nursing, Children's Hospital of Orange County, Orange, CA.
Pediatr Crit Care Med. 2018 Aug;19(8):755-759. doi: 10.1097/PCC.0000000000001629.
To evaluate the safety and efficacy of IV lidocaine in treating children and adolescents with status migraine.
Retrospective observational study.
Single center PICU.
Children and adolescents admitted with status migraine.
IV lidocaine.
Thirty-three lidocaine infusions were administered to 28 patients with status migraine. Two patients were excluded from analysis, leaving 31 infusions administered to 26 patients for analysis. Patients' ages ranged from 10 to 19 years with an average of 14.9 ± 2.4 years. Mean duration of hospitalization was 4.6 ± 1.5 days. Lidocaine was administered as a bolus (2.9 ± 0.18 mg/kg) in 80.6% (95% CI, 63.7-90.8%) of the patients, followed by an infusion, which was started at a mean rate of 1.29 ± 0.2 mg/kg/hr with mean maximum dose of 1.56 ± 0.27 mg/kg/hr. The highest lidocaine drip was 2.25 mg/kg/hr and lowest 1.125 mg/kg/hr. Lidocaine was interrupted in one patient secondary to side effects: chest pain and anxiety. On average, it took 16.3 ± 12.9 hours for 50% reduction in pain scores (range, 1.3-40.4 hr) and 19.3 ± 19.3 hours for complete resolution (0.8-72.1). 90.3% of cases (95% CI, 75.1-96.6%) experienced pain resolution with 51.6% (95% CI, 34.8-68%) encountering a relapse of pain. Mean pain scores at the time of discharge were 1 ± 1.6 (median, 0). Both mean reported highest and lowest scores dropped over the course of the 5 days from 5.1 ± 1.9 and 2.1 ± 2.4 on day 1 to 1.0 ± 1.4 and 0 on day 5 of therapy. One-way analysis by analysis of variance for high pain score by day was statistically significant with a p value of less than 0.01.
In the appropriate patient population, IV lidocaine may be a safe and effective treatment for children and adolescents with status migraine. Larger prospective studies need to be done not only to evaluate safety and efficacy but also the analgesic longevity of IV lidocaine post discharge.
评估 IV 利多卡因治疗儿童和青少年偏头痛状态的安全性和疗效。
回顾性观察研究。
单中心 PICU。
因偏头痛状态入院的儿童和青少年。
IV 利多卡因。
33 次利多卡因输注用于 28 例偏头痛状态患者。2 例患者被排除在分析之外，26 例患者的 31 次输注用于分析。患者年龄 10-19 岁，平均 14.9±2.4 岁。平均住院时间为 4.6±1.5 天。利多卡因以推注（2.9±0.18mg/kg）的形式给予 80.6%（95%CI，63.7-90.8%）的患者，随后以平均 1.29±0.2mg/kg/hr 的速度开始输注，平均最大剂量为 1.56±0.27mg/kg/hr。利多卡因滴注最高为 2.25mg/kg/hr，最低为 1.125mg/kg/hr。1 例患者因副作用（胸痛和焦虑）中断利多卡因输注。平均而言，疼痛评分降低 50%（范围 1.3-40.4 小时）需要 16.3±12.9 小时，完全缓解（0.8-72.1 小时）需要 19.3±19.3 小时。90.3%的病例（95%CI，75.1-96.6%）疼痛缓解，51.6%（95%CI，34.8-68%）出现疼痛复发。出院时平均疼痛评分 1±1.6（中位数，0）。平均报告的最高和最低评分在 5 天的治疗过程中从第 1 天的 5.1±1.9 和 2.1±2.4 降至第 5 天的 1.0±1.4 和 0。通过方差分析对高疼痛评分进行的单向分析具有统计学意义（p 值小于 0.01）。
在适当的患者人群中，IV 利多卡因可能是儿童和青少年偏头痛状态的一种安全有效的治疗方法。不仅需要进行更大的前瞻性研究来评估安全性和疗效，还需要评估 IV 利多卡因出院后的镇痛持续时间。
