Background and Aims The use of intravenous lidocaine therapy (IVLT) improves pain outcomes in certain adult populations, however, little evidence exists in paediatric populations. We aim to evaluate its impact in patients with adolescents idiopathic scoliosis(AIS) undergoing primary posterior spinal instrumentation and fusion (PSIF).
Methods ASA1 and ASA2 patients over 12-years-old undergoing PSIF surgery for AIS between January 2017 and December 2020 were reviewed retrospectively. Demographic data, anaesthetic and pain management were evaluated alongside postoperative outcome measures.
This service evaluation was deemed no to require ethical approval (http://www.hra-decisiontools.org.uk/research/docs/DefiningResearchTable_Oct2017-1.pdf) by our local clinical governance committee (Audit No. 6351)
Results 162 patients with a median age of 15.2(IQR:13.6–16.5[range 11.4–19.2])years underwent PSIF for AIS. 33/162(20.4%) were male and 129/162(79.6%) female. 73/162(45.1%) received IVLT at a median infusion-rate of 1.8(IQR: 1.5–1.9 [range 1.1–2.0])mg/kg/hr. These patients required significantly less fentanyl: intraoperatively (p=0.0182,95%CI=0.1–1.3), on day-1 (p=0.0032;95%CI=1.6–7.6) and day-2 (p=0.0104;95%CI=0.8–6.5 (see table 1); reported similar/lower pain scores (day 1: p=0.0494; 95%CI 0.0–0.8) and attained rehabilitation goals in similar timeframes.
Conclusions We observed the use of intraoperative IVLT to be associated with a significant reduction in early opiate requirements in paediatric PSIF, suggesting patients may benefit from earlier conversion from intravenous to oral opiates. This change has been implemented within our local Enhanced Recovery After Surgery Programme to facilitate earlier mobilization and discharge. Our patients reported similar levels of comfort and attained their rehabilitation goals in a similar timeframe. Further review and study is required to determine the optimal components and dosing within paediatric PSF ERAS programmes.
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