The effects of intravenous lidocaine infusion on hospital stay after major abdominal pediatric surgery. A randomized double-blinded study

Background: Lidocaine attenuates the stress response to surgery when given intravenously. This study investigated the effect of perioperative lidocaine infusion on hormonal responses, bowel function and hospital stay after major abdominal surgeries in pediatrics. Methods: After obtaining the Research Ethics Board (REB) approval and written informed parental consent, 80 pediatric patients aged 1-6 years, ASA II, III scheduled for abdominal major surgery were randomly allocated into two groups, each of forty children. Twenty minutes before induction, children in placebo group received saline in a rate of 1.5 ml/kg/h and those in lidocaine group received lidocaine 1.5 mg/kg intravenously then infusion of 1.5 mg/kg/h up to 6 h postoperatively. Length of hospital stay and return of bowel function were reported. Plasma cortisol was recorded at baseline, 10 min after continuous infusion, 5 min after intubation and 10 min after extubation. Serum lidocaine concentrations were recorded 10 min after start of infusion, 10 min and 4 h after extubation. Results: Patients in placebo group showed significant higher plasma cortisol concentrations (P = 0.001) in response to induction of anesthesia and extended postoperatively when compared to lidocaine group. Hospital stay was significantly less in lidocaine group (5 +/- 2 days) compared to placebo group (7 +/- 2 days; P = 0.03). Also, fentanyl (mu g/kg/d) requirement was significantly less in lidocaine group (5.4 +/- 2.9 on 1st postoperative day and 4.1 +/- 2.6 on 2nd postoperative day) compared to placebo group (14.4 +/- 2.5 on 1st postoperative day and 12.6 +/- 3.3 on 2nd postoperative day). Moreover, return of bowel function was earlier in lidocaine group compared to placebo group (19 +/- 6.2 h vs. 23 +/- 3.65 h respectively). Conclusion: Intravenous lidocaine infusion, started preoperatively and continued for 6 h postoperatively, attenuated stress response to major abdominal pediatric surgery. It also decreased hospital stay, opioid requirement and hastened return of bowel function. (C) 2013 Egyptian Society of Anesthesiologists. Production and hosting by Elsevier B.V. Open access under CC BY-NC-ND license.