Intravenous Lidocaine for Postoperative Pain in Children Undergoing Tonsillectomies: A Double-Blinded, Randomized, Placebo-Controlled Trial

Abstract

Background: Tonsillectomy is a commonly performed surgical procedure in children, and the recovery period can be associated with significant postoperative pain. Currently, there are no studies examining the efficacy of intravenous lidocaine in decreasing post-tonsillectomy pain in children. The aim of this study was to evaluate the efficacy of intravenous lidocaine for decreasing postsurgical pain in children undergoing tonsillectomy.

Methods: This study was a prospective, randomized, double-blinded clinical trial of children ages 4-10 years undergoing tonsillectomy with or without adenoidectomy. Subjects were assigned to 1 of 2 groups: (i) intravenous lidocaine bolus (1.5 mg/kg) at anesthesia induction followed by a continuous intraoperative and postoperative infusion dose (2 mg/kg/h) or (ii) the equivalent volume of saline for 1 hour. The primary outcome was opioid consumption in milligram morphine equivalents (MME) in the postanesthesia care unit. Secondary outcome measures included pain intensity in the postanesthesia care unit measured using the Children's Hospital of Eastern Ontario Pain Scale and emergence agitation measured using the Pediatric Anesthesia Emergence Delirium scale, postoperative nausea and vomiting, and parent-reported pain intensity and medication administration at home.

Results: Ninety subjects were randomized and 88 completed the study: 44 received lidocaine and 44 received saline. There was no difference in adjusted postanesthesia care unit morphine consumption per kg of body weight, difference -0.01 MME/kg (95% confidence interval [CI], -0.07 to 0.04; P = .627), or total morphine use, difference -0.03 MME/kg (95% CI, -0.08 to 0.03; P = .360) between groups. There was no significant difference in Children's Hospital of Eastern Ontario Pain Scale or Pediatric Anesthesia Emergence Delirium scale scores or ondansetron dose. In the first postoperative week, there were no differences in parent postoperative pain measures, nausea/vomiting, ibuprofen, acetaminophen, or opioid use.

Conclusions: The analysis showed no evidence for a clinical benefit of intraoperative lidocaine infusion in children undergoing tonsillectomy. Our findings highlight the importance of characterizing non-opioid analgesic techniques in children, which have previously shown promise in adults.