Intravenous Lidocaine in Children Undergoing Laparoscopic Appendectomy
Intravenous Lidocaine in Children Undergoing Laparoscopic Appendectomy
Intravenous lidocaine - a potent local anesthetic with analgesic and anti-inflammatory
 properties has been shown to be an effective adjunct that reduces intra and postoperative
 opioid consumption and facilitates pain management in adults. In children population
 promising but limited evidence is available. The study was planned to evaluate the efficacy
 of continuous intravenous infusion of lidocaine to reduce opioid consumption during and after
 laparoscopic appendectomy in children.
Postoperative pain in children is still one of the most under diagnosed and under treated
 medical problems. It affects post-surgery recovery, mortality and morbidity, limits mobility.
 Untreated pain not only causes child's suffering but can decrease the pain threshold in the
 future or lead to the development of chronic pain. Postoperative analgesia has been
 traditionally based on opioids but as their use can be associated with adverse effects
 prolonging hospital stay and affecting recovery current guidelines focus on multimodal
 approaches involving numerous analgesics with different mechanism of action. Growing evidence
 suggests that intravenous lidocaine reduces intra- and postoperative requirement for opioids.
 Lidocaine has been proved to have analgesic and anti-inflammatory properties. It is also a
 potent peripheral nervous system modulator inhibiting peripheral and central sensitization.
 The studies performed in adult population have proved the efficacy of systemic lidocaine in
 postoperative pain treatment. It is an effective adjunct that reduces opioids consumption and
 facilitates pain management. As such lidocaine infusion has been included in postoperative
 pain management guidelines for adults. Studies on children population have promising results
 but high quality randomized controlled trials are still missing.

 The proposed study has been planned to evaluate the efficacy of continuous infusion of
 lidocaine as an adjunct to standard general anesthesia (involving fentanyl and sevoflurane)
 in reducing opioids consumption and facilitating postoperative pain control in children
 undergoing laparoscopic appendectomy.
Inclusion Criteria:

 1. Age between 18 months and 18 year-old

 2. Patients with American Society of Anaesthesiologists physical status (ASA) class 1/1E,
 2/2E, 3/3E

 3. Patients undergoing laparoscopic appendectomy

 Exclusion Criteria:

 1. Allergy to local anesthetics or contraindication to use of lidocaine

 2. Patients with American Society of Anaesthesiologists physical status (ASA) IV or more.

 3. Severe cardiovascular disease

 4. Preoperative bradycardia

 5. Preoperative atrioventricular block

 6. Renal failure

 7. Chronic treatment with analgesics

 8. Parents' refusal