P78
A SYSTEMATIC REVIEW CONDUCTED ON THE USE OF INTRAVENOUS LIDOCAINE AND ITS EFFECTS ON POST-OPERATIVE PAIN IN PAEDIATRIC ANAESTHESIA
A.Akhtar, University of Manchester, UK
Introduction and aims
Lidocaine is commonly used as a local anaesthetic, but it has also been found to have useful properties as an analgesic adjunct in surgery. Currently, there is a wide range of evidence supporting the use of intravenous lidocaine in reducing post-operative pain in adults, and the Association of Anaesthetists have published a consensus with guidelines to ensure safe use of intravenous lidocaine. While there is a lot of evidence supporting use of intravenous lidocaine in adult anaesthesia, there is not much evidence of its use in paediatrics. This review aims to find and assess trials using intravenous lidocaine in paediatric surgery to evaluate its efficacy in paediatric populations.
The aim of this review using the different aspects of PICO (patient, intervention, control, outcome) is:
- P: patients aged < 18 years undergoing surgery
- I: use of IV lidocaine
- C: either use of a placebo or simply not being given IV lidocaine
- O: degree of post-operative pain
Methods
6 different databases were searched using keywords to maximise search results. A screening software was used to remove any duplicates, and then the titles and abstracts were screened. The relevant inclusion and exclusion criteria were applied, and studies that passed this stage of screening moved on to a full text review. After a full text review, six studies were included in the final review. Each study was assessed for its risk of bias individually using the Cochrane Risk of Bias Tool. From the included studies, data was extracted about their characteristics and about their results, including the dose and duration of lidocaine, the control used, and how pain was measured.
Results
The results of the search yielded 383 studies. 57 articles were retrieved for the final stage of screening, and of these six were utilised in composing the final review. The risk of bias overall was low in all six of the studies included in this review. five out of six of the studies had statistically significant results showing that use of intravenous lidocaine had some form of positive effect on reduction of post-operative pain, whether this was by reducing post-operative pain scores, or by reducing post-operative opioid consumption.
Discussion and conclusion
Overall, intravenous lidocaine has been shown to have promising results as an analgesic adjunct in paediatric surgery. The only study out of the six that didn’t show a reduction in post-operative pain from using intravenous lidocaine, did see a reduction in post-operative nausea and vomiting. This shows that lidocaine may be a useful adjunct in reducing other post-operative complications. However, further research needs to be done using larger population sizes and across a variety of different surgeries to further evaluate its efficacy within both minor and major procedures.