Postoperative Use and Early Discontinuation of Intravenous Lidocaine in Spine Patients

Overview

Journal Spine Deform

Publisher Springer Nature

Date 2023 Aug 23

PMID 37610553

Authors

Paul Brian O Soriano

Jason J Haselhuhn

Joseph C Resch

Gwenyth A Fischer

Dana B Swanson

Kenneth J Holton

David W Polly Jr

Affiliations

Soon will be listed here.

Abstract

Purpose: Our institution employs a multimodal approach to manage postoperative pain after spine surgery. It involves continuous intravenous (IV) lidocaine until the morning of postoperative day two. This study aimed to determine the rate and reasons for early discontinuation of IV lidocaine in our spine patients.

Methods: We conducted a retrospective chart review and included pediatric patients who underwent ≥ 3-level spine surgery and received postoperative IV lidocaine from November 2019 to September 2022. For each case, we recorded the side effects of IV lidocaine, adverse events, time to discontinuation, and discontinuation rate. Subsequently, we used the same methodology to generate an adult cohort for comparison.

Results: We included 52 pediatric (18M:34F) and 50 (21M:29F) adult patients. The pediatric cohort's mean age was 14 years (8-18), and BMI 23.9 kg/m (13.0-42.8). The adult cohort's mean age was 61 years (29-82), and BMI 28.8 kg/m (17.2-44.1). IV lidocaine was discontinued prematurely in 21/52 (40.4%) of the pediatric cases and 26/50 (52.0%) of the adult cases (RR = 0.78, p = 0.2428). The side effects noted in the pediatric cases vary, including numbness, visual disturbance, and obtundation, but no seizures. The most common adverse events were fever and motor dysfunction.

Conclusion: The early discontinuation rate of IV lidocaine use after spine surgery for children in our institution does not differ significantly from that of adults. The nature of the side effects and the reasons for discontinuation between the groups were similar. Thus, the safety profile of IV lidocaine for pediatric spine patients is comparable to adults.

References

Licina A, Silvers A . Perioperative Intravenous Lidocaine Infusion for Postoperative Analgesia in Patients Undergoing Surgery of the Spine: Systematic Review and Meta-Analysis. Pain Med. 2021; 23(1):45-56. DOI: 10.1093/pm/pnab210. View

Yoo J, Ahn J, Buvanendran A, Singh K . Multimodal analgesia in pain management after spine surgery. J Spine Surg. 2019; 5(Suppl 2):S154-S159. PMC: 6790807. DOI: 10.21037/jss.2019.05.04. View

Chou R, Gordon D, de Leon-Casasola O, Rosenberg J, Bickler S, Brennan T . Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive.... J Pain. 2016; 17(2):131-57. DOI: 10.1016/j.jpain.2015.12.008. View

Klemme W, Burkhalter W, Polly Jr D, Dahl L, Davis D . Reversible ischemic myelopathy during scoliosis surgery: a possible role for intravenous lidocaine. J Pediatr Orthop. 1999; 19(6):763-5. View

Prabhakar N, Chadwick A, Nwaneshiudu C, Aggarwal A, Salmasi V, Lii T . Management of Postoperative Pain in Patients Following Spine Surgery: A Narrative Review. Int J Gen Med. 2022; 15:4535-4549. PMC: 9075013. DOI: 10.2147/IJGM.S292698. View

Cassuto J, Wallin G, HOGSTROM S, Faxen A, Rimback G . Inhibition of postoperative pain by continuous low-dose intravenous infusion of lidocaine. Anesth Analg. 1985; 64(10):971-4. View

Baral B, Bhattarai B, Rahman T, Singh S, Regmi R . Perioperative intravenous lidocaine infusion on postoperative pain relief in patients undergoing upper abdominal surgery. Nepal Med Coll J. 2011; 12(4):215-20. View

De Oliveira Jr G, FitzGerald P, Streicher L, Marcus R, McCarthy R . Systemic lidocaine to improve postoperative quality of recovery after ambulatory laparoscopic surgery. Anesth Analg. 2012; 115(2):262-7. DOI: 10.1213/ANE.0b013e318257a380. View

Vigneault L, Turgeon A, Cote D, Lauzier F, Zarychanski R, Moore L . Perioperative intravenous lidocaine infusion for postoperative pain control: a meta-analysis of randomized controlled trials. Can J Anaesth. 2010; 58(1):22-37. DOI: 10.1007/s12630-010-9407-0. View

10.

Chu R, Umukoro N, Greer T, Roberts J, Adekoya P, Odonkor C . Intravenous Lidocaine Infusion for the Management of Early Postoperative Pain: A Comprehensive Review of Controlled Trials. Psychopharmacol Bull. 2021; 50(4 Suppl 1):216-259. PMC: 7901134. View

11.

Haratian A, Musa A, Field R, Farhan S, Bennett C, Cooke C . Intravenous lidocaine in spine surgery: A meta-analysis of randomized controlled trials. N Am Spine Soc J. 2022; 7:100079. PMC: 8819964. DOI: 10.1016/j.xnsj.2021.100079. View

12.

Sriganesh K, Bharadwaj S, Shanthanna H, Umamaheswara Rao G, Kramer B, Sathyaprabha T . Opioid versus non-opioid analgesia for spine surgery: a systematic review and meta-analysis of randomized controlled trials. Eur Spine J. 2022; 32(1):289-300. DOI: 10.1007/s00586-022-07469-4. View

13.

Phillips M, Adamson W, E McLean S, Hance L, Lupa M, Pittenger S . Implementation of a pediatric enhanced recovery pathway decreases opioid utilization and shortens time to full feeding. J Pediatr Surg. 2019; 55(1):101-105. DOI: 10.1016/j.jpedsurg.2019.09.065. View

14.

Ljungqvist O, Scott M, Fearon K . Enhanced Recovery After Surgery: A Review. JAMA Surg. 2017; 152(3):292-298. DOI: 10.1001/jamasurg.2016.4952. View

15.

Yeung S, Hilkewich L, Gillis C, Heine J, Fenton T . Protein intakes are associated with reduced length of stay: a comparison between Enhanced Recovery After Surgery (ERAS) and conventional care after elective colorectal surgery. Am J Clin Nutr. 2017; 106(1):44-51. DOI: 10.3945/ajcn.116.148619. View

16.

West M, Horwood J, Staves S, Jones C, Goulden M, Minford J . Potential benefits of fast-track concepts in paediatric colorectal surgery. J Pediatr Surg. 2013; 48(9):1924-30. DOI: 10.1016/j.jpedsurg.2013.02.063. View

17.

Bakan M, Umutoglu T, Topuz U, Uysal H, Bayram M, Kadioglu H . Opioid-free total intravenous anesthesia with propofol, dexmedetomidine and lidocaine infusions for laparoscopic cholecystectomy: a prospective, randomized, double-blinded study. Braz J Anesthesiol. 2015; 65(3):191-9. DOI: 10.1016/j.bjane.2014.05.001. View

18.

Zhu B, Zhou X, Zhou Q, Wang H, Wang S, Luo K . Intra-Venous Lidocaine to Relieve Neuropathic Pain: A Systematic Review and Meta-Analysis. Front Neurol. 2019; 10:954. PMC: 6759769. DOI: 10.3389/fneur.2019.00954. View

19.

Batko I, Koscielniak-Merak B, Tomasik P, Kobylarz K, Wordliczek J . Lidocaine as an element of multimodal analgesic therapy in major spine surgical procedures in children: a prospective, randomized, double-blind study. Pharmacol Rep. 2020; 72(3):744-755. PMC: 7329801. DOI: 10.1007/s43440-020-00100-7. View

20.

Lemming K, Fang G, Buck M . Safety and Tolerability of Lidocaine Infusions as a Component of Multimodal Postoperative Analgesia in Children. J Pediatr Pharmacol Ther. 2019; 24(1):34-38. PMC: 6397014. DOI: 10.5863/1551-6776-24.1.34. View