Preliminary Experience With a Continuous Lidocaine Infusion as an Analgesia Adjunct for Acute Pain Management Following Surgery in Pediatric Patients
Bibliographic record
Abstract
Background: Lidocaine is a local anesthetic of the amide class that has been used for various therapeutic interventions. Its potential analgesic effects have been reported in anecdotal reports and larger clinical trials. Methods: We retrospectively reviewed our 24-month experience with the use of lidocaine outside of the intensive care unit (ICU) setting as an adjunct to acute pain management following major surgical procedures in children and adolescents. Results: The study cohort included 168 patients (mean age 13.8 years). The majority of patients (N = 142) underwent a posterior spinal fusion for treatment of scoliosis (idiopathic or neuromuscular). Thirty-one patients received a bolus dose followed by an infusion starting at 0.2 to 2 mg/kg/h (average dose 0.97 mg/kg/h). Most patients (86.3%) received a continuous lidocaine infusion for 1 - 3 days at an average dose of 1 mg/kg/h. Lidocaine was infused for a total of 503 days in the study cohort of 168 patients. Despite that these were major surgical procedures, pain scores were generally acceptable. The lidocaine infusion was discontinued or decreased in eight patients due to concerns of adverse effects. Adverse effects were noted in 38 days of the 503 days of infusion (7.6%). A total of 29 patients (17.3%) experienced at least one adverse effect. The majority of these were related to the central nervous system (CNS) including blurred vision, dizziness, drowsiness/difficult to arouse, delirium, hallucinations, agitation, confusion, delirium, hallucinations, agitation, and confusion. Conclusions: We present the largest study to date outlining the use of lidocaine as an adjunct to acute pain management in children and adolescents. These preliminary data suggest that with enhanced clinical observation for signs of potential toxicity and increased clinical monitoring of vital signs, the lidocaine infusion can be administered on the inpatient ward without routine serum concentration monitoring. The current cohort and other studies in pediatric patients provide a background for prospective studies to evaluate dosing regimens, optimal patient populations, and analgesic efficacy. Int J Clin Pediatr. 2023;12(2):29-36 doi: https://doi.org/10.14740/ijcp522
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".