Title: Intravenous Lidocaine for Postoperative Pain in Children Undergoing Tonsillectomies: A Double-Blinded, Randomized, Placebo-Controlled Trial
Introduction:
•Tonsillectomy is a commonly performed surgical procedure in children that is associated with significant postoperative pain 1-3.
•Traditional opioid use can suppress respiration, especially in children with obstructive sleep apnea, which is the leading indicator of tonsillectomy 4.
•Lidocaine is an amide-type local anesthetic that has been shown to effectively reduce postoperative pain in some surgical models and not others 5.
•Currently, there are no studies that examine the efficacy of intravenous lidocaine at preventing post-tonsillectomy pain in children.
•This study aimed to evaluate the efficacy of intravenous lidocaine for preventing postsurgical pain in children undergoing tonsillectomy.
Methods:
•This study was a prospective, randomized, double-blinded control trial. The Ann & Robert H. Lurie Children’s Hospital of Chicago Institutional Review Board (IRB) approved this study (2015-741; 09-28-2015).
•Eligible participants included children aged 4-10 years with an American Society of Anesthesiologists (ASA) physical status classification of I-III, scheduled for tonsillectomy performed by either of two surgeons (KRB and SRH) utilizing a standardized surgical technique.
•Subjects were randomly assigned to one of two groups: i) one bolus (1.5 mg/kg) and one continuous infusion dose (2 mg/kg/hr) of intravenous lidocaine, or ii) the equivalent volume of saline.
•The primary outcome was opioid consumption in the post-anesthesia care unit (PACU).
•Secondary outcome measures included pain intensity in the PACU measured using the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) and emergence agitation measured using the Pediatric Anesthesia Emergence Delirium (PAED) scale, postoperative nausea and vomiting, and parent-reported pain intensity and medication administration at home.
Results:
•n=44 participants received the lidocaine bolus and infusion, while n=44 received the saline equivalent.
•There were no differences in baseline characteristics between groups in both unweighted and propensity score weighted cohorts (Table 1).
•There was no significant difference in CHEOPS total scores or PAED scores during the first 30 minutes postoperatively between the two groups (Figure 1).
•There were no significant differences in the percentage of patients receiving opioid analgesics (P = 0.421), PACU morphine consumption (P = 0.532), or total postoperative morphine milligram equivalents (MME/kg) (P = 0.579) between groups.
•Ibuprofen and acetaminophen use in the first postoperative week did not differ significantly (P = 0.796; P = 0.914; Figure 2).
Discussion:
•We found no evidence for a clinical benefit of lidocaine infusion for children undergoing tonsillectomies.
References:
[1] Guntinas-Lichius O, Volk GF, Geissler K, Komann M, Meissner W. Pain after pediatric otorhinolaryngologic surgery: a prospective multi-center trial. Eur Arch Otorhinolaryngol. 2014; 271:2049–60. [PubMed: 24510234]
[2] Vons KM, Bijker JB, Verwijs EW, Majoor MH, de Graaff JC. Postoperative pain during the first week after adenoidectomy and guillotine adenotonsillectomy in children. Paediatr Anaesth. 2014; 24:476–82. [PubMed: 24646093]
[3] Stewart DW, Ragg PG, Sheppard S, Chalkiadis GA. The severity and duration of postoperative pain and analgesia requirements in children after tonsillectomy, orchidopexy, or inguinal hernia repair. Paediatr Anaesth. 2012; 22:136–43. [PubMed: 22023485]
[4] Nguyen, B. K., & Quraishi, H. A. (2022). Tonsillectomy and Adenoidectomy - Pediatric Clinics of North America. In Pediatric Clinics of North America (Vol. 69, Issue 2, pp. 247–259). Elsevier BV. https://doi.org/10.1016/j.pcl.2021.12.008
[5] McCarthy GC, Megalla SA, Habib AS. Impact of intravenous lidocaine infusion on postoperative analgesia and recovery from surgery: a systematic review of randomized controlled trials. Drugs. 2010;70(9):1149-1163.
