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Updated: Sep 26, 2025
An Experimental Paradigm for the Prediction of Post-Operative Pain PPOP
Published on: January 27, 2010
Lidocaine for dinutuximab-associated pain? A multicenter retrospective observational cohort study
Julianna Featherly1,2, Sarabeth Baxter Wojnowicz1,2, Kelly Steidl1,2
1Upstate University Hospital, Syracuse, New York.
Background:
Dinutuximab, an immune-mediated therapy indicated for high-risk neuroblastoma, targets the protein disialoganglioside (GD2) on neuroblastoma cells, neurons, and peripheral nerve fibers. Off-target effects lead to severe nerve pain. Pain regimens including continuous infusion opioids are required during treatment courses. Our institution utilizes a combination of intravenous (i.v.) lidocaine infusions and morphine for the treatment of dinutuximab-associated neuropathic pain.
Objective:
The primary outcome of this study was to compare morphine equivalents for cycle 1 of dinutuximab at an institution that uses i.v. lidocaine (primary) versus those that do not (comparison). Secondary outcomes included both dinutuximab infusion time and safety of i.v. lidocaine.
Methods:
A retrospective, multicentered, electronic chart review was performed at three tertiary academic medical centers. Patients between 0 and 18 years of age during their first course of dinutuximab were included to evaluate the primary outcome of adjuvant morphine equivalents needed.
Results:
Twenty-one patients were identified for inclusion. Total morphine equivalents at the primary institution were 1.87 mg/kg versus 1.79 mg/kg at the comparison institutions (P = 0.413). Dinutuximab infusion time was statistically significantly less at the primary institution: 610.5 minutes versus 676.23 minutes (P = 0.046). Only one patient at the primary institution experienced nausea, vomiting, and paresthesias.
Conclusions:
This study did not find a statistically significant difference in morphine equivalents between patients receiving i.v. lidocaine and those who did not. Lidocaine use resulted in a statistically significant lower dinutuximab infusion time. Our data suggest it is a safe adjuvant medication, for use outside of the pediatric intensive care unit, in the treatment of dinutuximab-associated neuropathic pain.
Insights
Intravenous lidocaine did not significantly reduce opioid use for dinutuximab-associated pain, but it did shorten infusion times. This study suggests lidocaine is a safe option for managing neuropathic pain in neuroblastoma patients.
Area of Science:
- Pediatric Oncology
- Neuroscience
- Pharmacology
Background:
- Dinutuximab targets GD2, causing neuropathic pain due to off-target effects on nerve fibers.
- High-risk neuroblastoma treatment requires managing severe pain, often with continuous opioid infusions.
- Intravenous (IV) lidocaine is used alongside morphine at some institutions to treat dinutuximab-associated pain.
Purpose of the Study:
- To compare opioid (morphine equivalent) consumption during cycle 1 of dinutuximab treatment.
- To evaluate the impact of IV lidocaine on dinutuximab infusion duration.
- To assess the safety profile of IV lidocaine as an adjuvant therapy.
Main Methods:
- Retrospective, multicentered chart review of patients aged 0-18 receiving their first dinutuximab course.
- Comparison of morphine equivalents between an institution using IV lidocaine and those not using it.
- Analysis of dinutuximab infusion times and adverse events.
Main Results:
- No statistically significant difference in total morphine equivalents (1.87 mg/kg vs. 1.79 mg/kg) was found.
- Dinutuximab infusion time was significantly shorter at the institution using IV lidocaine (610.5 min vs. 676.23 min).
- Adverse events associated with lidocaine were minimal, with only one patient experiencing nausea, vomiting, and paresthesias.
Conclusions:
- IV lidocaine did not significantly alter opioid requirements for dinutuximab-induced pain.
- IV lidocaine use was associated with a statistically significant reduction in dinutuximab infusion time.
- IV lidocaine appears to be a safe adjuvant medication for managing neuropathic pain outside the pediatric intensive care unit.
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