Department of Pediatric Anesthesiology and Intensive Care, Medical University of Warsaw University Clinical Centre, ul. Żwirki i Wigury 63A, 02-091, Warsaw, Poland.
Department of Anesthesiology and Intensive Care, Division of Teaching, Medical University of Warsaw, ul. Lindleya 4, 02-005, Warsaw, Poland.
BMC Anesthesiol. 2021 Jan 5;21(1):2. doi: 10.1186/s12871-020-01218-0.
Intravenous lidocaine, a potent local anesthetic with analgesic and anti-inflammatory properties, has been shown to be an effective adjunct that reduces intra- and postoperative opioid consumption and facilitates pain management in adults. While it shows promise for use in the pediatric population, limited evidence is available.
To determine if general anesthesia with intraoperative intravenous lidocaine infusion versus general anesthesia without intravenous lidocaine infusion in children undergoing laparoscopic appendectomy decreased opioid requirements intra- and postoperatively.
A single-center parallel single-masked randomized controlled study. A computer-generated blocked randomization list was used to allocate participants. The study was conducted between March 2019 and January 2020.
Pediatric teaching hospital in Poland.
Seventy-four patients aged between 18 months and 18 years undergoing laparoscopic appendectomy. Seventy-one patients fulfilled the study requirements.
Intravenous lidocaine bolus of 1.5 mg/kg over 5 min before induction of anesthesia followed by lidocaine infusion at 1.5 mg/kg/h intraoperatively. The infusion was discontinued before the patients' transfer to the postanesthesia care unit (PACU).
The primary outcome measure was total nalbuphine requirement in milligrams during the first 24 h after surgery.
The secondary outcome measures were intraoperative fentanyl consumption, intraoperative sevoflurane consumption, time to the first rescue analgesic request, incidence of postoperative nausea and vomiting during the first 24 h after surgery, frequency of side effects of lidocaine.
Children (n = 74) aged 5-17 randomly allocated to receive intraoperative lidocaine infusion (n = 37) or no intervention (n = 37). Seventy-one were included in the analysis (35 in the study group and 36 in the control group). There was no difference in the cumulative dose of nalbuphine in the first 24 h after removal of the endotracheal tube between groups [median of 0.1061 (IQR: 0.0962-0.2222) mg/kg in the lidocaine group, compared to the control group median of 0.1325 (IQR: 0.0899-0.22020) mg/kg, p = 0.63]. Intraoperative fentanyl consumption was lower in the lidocaine group [median of 5.091 (IQR: 4.848-5.714) μg/kg] than in the control group [median of 5.969 (IQR: 5.000-6.748), p = 0.03]. Taking into account the additional doses administered based on clinical indications, the reduction in the requirement for fentanyl in the lidocaine group was even greater [median of 0.0 (IQR: 0.0-0.952) vs 0.99 (IQR: 0.0-1.809) μg/kg, p = 0.01]. No difference was observed in the sevoflurane consumption between the two groups [median of 32.5 ml (IQR 25.0-43.0) in the lidocaine group vs median of 35.0 ml (IQR: 23.5-46.0) in the control group, p = 0.56]. The time to first analgesic request in the lidocaine group was prolonged [median of 55 (IQR: 40-110) min in the lidocaine group vs median of 40.5 (IQR: 28-65) min in the control group, p = 0.05]. There was no difference in the frequency of PONV between the two groups (48.57% in the lidocaine group vs 61.11% in the control group, p = 0.29). No lidocaine related incidence of anaphylaxis, systemic toxicity, circulatory disturbances or neurological impairment was reported, during anesthesia or postoperative period.
Intraoperative systemic lidocaine administration 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.
NCT03886896 .
静脉内利多卡因作为一种具有镇痛和抗炎作用的强效局部麻醉剂，已被证明是一种有效的辅助药物，可减少围手术期阿片类药物的消耗，并有助于成人的疼痛管理。尽管它在儿科人群中显示出应用的前景，但可用的证据有限。
确定在接受腹腔镜阑尾切除术的儿童中，全身麻醉加术中静脉内利多卡因输注与全身麻醉不伴静脉内利多卡因输注相比，是否会降低围手术期阿片类药物的需求。
单中心平行单盲随机对照研究。使用计算机生成的分组随机列表对参与者进行分组。研究于 2019 年 3 月至 2020 年 1 月在波兰的一所儿科教学医院进行。
74 名年龄在 18 个月至 18 岁之间的患者，接受腹腔镜阑尾切除术。71 名患者符合研究要求。
在麻醉诱导前静脉注射 1.5mg/kg 的利多卡因负荷量，持续 5 分钟，然后在手术期间以 1.5mg/kg/h 的速度输注。在患者转移到麻醉后护理单元（PACU）之前停止输注。
主要结局测量指标是术后 24 小时内总纳布啡的需求量。
次要结局测量指标包括术中芬太尼的消耗量、术中七氟醚的消耗量、首次需要抢救性镇痛的时间、术后 24 小时内恶心和呕吐的发生率、利多卡因的副作用发生率。
5-17 岁的儿童（n=74）随机分配接受术中利多卡因输注（n=37）或无干预（n=37）。71 名患者被纳入分析（研究组 35 名，对照组 36 名）。两组患者在拔除气管导管后 24 小时内的纳布啡累积剂量无差异[研究组中位数为 0.1061（IQR：0.0962-0.2222）mg/kg，对照组中位数为 0.1325（IQR：0.0899-0.22020）mg/kg，p=0.63]。研究组术中芬太尼的消耗量较低[中位数为 5.091（IQR：4.848-5.714）μg/kg]，而对照组为 5.969（IQR：5.000-6.748）μg/kg，p=0.03]。考虑到根据临床指征给予的额外剂量，研究组对芬太尼的需求减少更为显著[中位数为 0.0（IQR：0.0-0.952）vs 0.99（IQR：0.0-1.809）μg/kg，p=0.01]。两组患者七氟醚的消耗量无差异[研究组中位数为 32.5ml（IQR 25.0-43.0），对照组中位数为 35.0ml（IQR：23.5-46.0），p=0.56]。研究组首次镇痛请求的时间延长[研究组中位数为 55（IQR 40-110）min，对照组中位数为 40.5（IQR 28-65）min，p=0.05]。两组患者术后恶心和呕吐的发生率无差异（研究组 48.57%，对照组 61.11%，p=0.29）。在麻醉或术后期间，没有报告与利多卡因相关的过敏反应、全身毒性、循环障碍或神经损伤的发生。
术中全身给予利多卡因可减少接受腹腔镜阑尾切除术的儿童术中阿片类药物的需求。这种作用是时间有限的，因此在停止利多卡因输注后 24 小时内不会影响阿片类药物的消耗。
NCT03886896 。
