Background and Goal of Study: Intravenous lidocaine can cause visceral analgesia and reduce opioid requirements during and after abdominal surgery.
Materials and methods: Twenty-one 3 to 7 year old children with acute appendicitis were randomized into 2 groups (lidocain “L”, n=11 and control C"”, n=10) before open appendectomy. Intravenous induction and maintenance of anaesthesia with propofol (3 mg/kg and 6 mg/kg*hour, respectively), single-shot right side thoraco-lumbar paravertebral block (PVB) at T12-L1 level (bupivacaine 0.25%, 0.3 ml/kg) under local anaesthesia and neurostimulation guidance were performed in all children. In all children of “L” group intravenous lidocaine 30 minutes before surgery was administered (1.5 mg/kg bolus followed with 1.5 mg/kg*hour infusion until surgery was over). If there was motor or hemodynamic response to surgical stimulation, fentanyl boluses 1 mcg/kg were used in both groups until movements or tachycardia/hypertension disappeared.
Results and discussion: Postoperative opioid dose, NSAIDs dose and pain scores (FLACC scale or Wong-Baker scale) did not differ between groups. Intraoperative fentanyl dose was significantly lower in “L” group compared to “C” group (0.4±0.009 mcg/kg vs 1.8±0.011 mcg/kg respectively, P=0.012). Number of postoperative respiratory depression episodes did not differ between groups (0 vs 1 respectively, P=0.48). Postoperative sedation was deeper in “C” group compared to “L” group. Ramsay sedation scores postoperativly were in “L” group: in 0 min - 3.9±0.9**; in10 min - 2.7±0.7**; in 20 min - 1.7±0.5*; in 30 min - 1±0.3; in 60 min -1±0.1; and in "C" group: 5.1±0.8; 4.1±0.4; 3.3±0.6; 1.6±0.2; 1±0.08, respectively.
(** - P< 0.01; * - P< 0.05 compared to “C” group). Children of “L” group were discharged from recovery room earlier compared to children of “C” group, but the difference did not reach statistical significance (19.5±7.9 vs 28.7±9.8 minutes respectively, P=0.067). Incidence of postoperative nausea/vomiting (PONV) was lower in “L” group compared to “C” group (0 vs 4 respectively, P=0.035).
Conclusion(s): Intraoperative intravenous lidocaine infusion in addition to thoraco-lumbar PVB for appendectomy in children leads to significant intraoperative fentanyl dose reduction and reduces the incidence of opioid-related adverse events, such as excessive postoperative sedation, delayed recovery room discharge and PONV.

Intravenous lidocaine as an adjunct to thoraco-lumbar paravertebral block for open appendectomy in children