Department of Anesthesiology and Intensive Care, University Children's Hospital, 265 Wielicka St, 30-663, Cracow, Poland.
Department of Clinical Biochemistry, University Children's Hospital, Jagiellonian University Medical College, Cracow, Poland.
Pharmacol Rep. 2020 Jun;72(3):744-755. doi: 10.1007/s43440-020-00100-7. Epub 2020 Apr 15.
Introducing the principles of multimodal analgesic therapy is necessary to provide appropriate comfort for the patient after surgery. The main objective of the study was evaluating the influence of perioperative intravenous (i.v.) lidocaine infusion on postoperative morphine requirements during the first 48 h postoperatively in children undergoing major spine surgery.
Prospective, randomized, double-blind study: 41 children, qualified to multilevel spine surgery, were randomly divided into two treatment groups: lidocaine and placebo (control). The lidocaine group received lidocaine as a bolus of 1.5 mg/kg over 30 minutes, followed by a continuous infusion at 1 mg/kg/h to 6 hours after surgery. The protocol of perioperative management was identical for all patients.
morphine demand, intensity of postoperative pain (the Numerical Rating Scale), oral feeding initiation time, first attempts at assuming erect position, postoperative quality of life (the Acute Short-form /SF-12/ health survey).
Patient data did not differ demographically. Compared to the control group, lidocaine treatment reduced the demand for morphine during the first 24h [95% CI 0.13 (0.11-0.28) mg/kg, p = 0.0122], 48h [95% CI 0.46 (0.22-0.52) mg/kg, p = 0.0299] after surgery and entire hospitalization [95% CI 0.58 (0.19-0.78) mg/kg, p = 0.04]; postoperative pain intensity; nutritional withdrawal period [introduction of liquid diet (p = 0.024) and solid diet (p = 0.012)], and accelerated the adoption of an upright position [sitting (p = 0.048); walking (p = 0.049)]. The SF-12 generic health survey did not differ between groups before operation, 2 months and 4 years after surgery.
Perioperative lidocaine administration, as a part of the applied analgesic therapy regimen, may decrease postoperative opioid demand and accelerates convalescence of children undergoing major surgery.
介绍多模式镇痛治疗的原则对于手术后为患者提供适当的舒适度是必要的。本研究的主要目的是评估围手术期静脉（i.v.）利多卡因输注对行大脊柱手术的儿童术后 48 小时内吗啡需求的影响。
前瞻性、随机、双盲研究：41 名符合多节段脊柱手术条件的儿童随机分为两组：利多卡因组和安慰剂（对照组）。利多卡因组在 30 分钟内给予 1.5mg/kg 的利多卡因负荷量，然后在术后 6 小时内以 1mg/kg/h 的速度持续输注。所有患者的围手术期管理方案相同。
吗啡需求、术后疼痛强度（数字评分量表）、开始口服喂养时间、首次尝试直立位、术后生活质量（急性短期 /SF-12/健康调查）。
患者数据在人口统计学上没有差异。与对照组相比，利多卡因治疗组在术后前 24 小时[95%CI0.13（0.11-0.28）mg/kg，p=0.0122]、48 小时[95%CI0.46（0.22-0.52）mg/kg，p=0.0299]和整个住院期间[95%CI0.58（0.19-0.78）mg/kg，p=0.04]的吗啡需求减少；术后疼痛强度；营养剥夺期[引入液体饮食（p=0.024）和固体饮食（p=0.012）]，并加速了直立姿势的采用[坐姿（p=0.048）；行走（p=0.049）]。SF-12 通用健康调查在手术前、手术后 2 个月和 4 年时两组之间没有差异。
作为应用镇痛治疗方案的一部分，围手术期给予利多卡因可能会减少术后阿片类药物的需求，并加速大手术儿童的康复。
