Electrophysiologic cardiac safety of intravenous lidocaine infusion in children

U. Fesenko1, V. Perova-Sharonova2, A. Albokrinov2 

1 Lviv National Danylo Halytsky Medical University, Lviv, Ukraine
2 Lviv Regional Children’s Clinic Hospital, Lviv, Ukraine

Background
Intravenous (IV) lidocaine infusion is widely used for intraoperative (IO) and postoperative (PO) analgesia and PO ileus treatment after abdominal surgery. There is speculation in scientific literature about similar efficacy and less invasiveness of IV lidocaine infusion compared to epidural anesthesia (EA). Effect of IV lidocaine infusion on cardiac electrophysiology in children is not studied well. 

Objective
To study the effect of PO IV lidocaine infusion on basic cardiac conduction intervals in children.

Materials and methods
Twenty-one 6 to 14 years old children with acute appendicular peritonitis or acute bowel obstruction due to intestinal/colo-intestinal intussusception who undergone surgical treatment were randomized into 2 groups (“EA”, n=12 and “IV Lidocaine”, n=9) before surgery. Children with cardiac pathology were excluded from this study. Groups did not differ in diagnosis, age, body weight, sex and ASA physical status. Propofol/fentanyl-based total IV anesthesia with mechanical ventilation was used for induction and maintenance of general anesthesia. In “EA” group EA was performed in lateral position at Th12-L1 level and EA catheter was advanced 3-5 cm cranially. Bupivacaine 0.25% 0.5 ml/kg bolus was administered prior to surgery and bupivacaine 0.25% infusion 4-6 ml/kg*h was started. In “IV Lidocaine” group 1.5 mg/kg IV lidocaine bolus was administered 30 min prior to surgery and IV lidocaine infusion 1.5 mg/kg*h was started. Epidural bupivacaine and IV lidocaine infusions lasted 3 PO days. Besides standard IO and PO monitoring, Holter monitoring during 3 PO days was used to analyze ECG intervals (PQ, QRS, QTc).

Results
HR and basic ECG intervals did not differ significantly between groups. Main study results are shown in Table 1.

Table 1. HR and basic ECG intervals in “EA” and “IV Lidocaine” groups (Mean±SD).
	IV lidocaine	EA	P
PQ (ms)	161.4±23.4	157.1±23.6	0.74
QRS (ms)	75.7±18.1	74.3±16.2	0.88
QTc (ms)	421.3±42.1	408.0±48.0	0.59
HR (bpm)	92.6±13.3	84.6±19.1	0.38

Conclusion
IV lidocaine administration in recommended doses (1.5 mg/kg bolus followed by 1.5 mg/kg*h infusion) is safe in terms of cardiac electrophysiology in children.