Lidocaine and risk of postoperative vomiting in children undergoing tonsillectomy: a randomised clinical trial

Area of Science:

• Anesthesiology
• Pediatric Surgery
• Pharmacology

Background:

• Postoperative vomiting (POV) is a common complication in pediatric tonsillectomy.
• The optimal intravenous lidocaine dosage for preventing POV in children is not well-established.

Purpose of the Study:

• To investigate the dose-response relationship of intravenous lidocaine in preventing POV within 24 hours post-tonsillectomy in children.
• To evaluate the efficacy of different intravenous lidocaine doses on reducing postoperative analgesic requirements.

Main Methods:

• A randomized controlled trial involving 3-12 year old patients undergoing tonsillectomy (with or without adenoidectomy).
• Patients were allocated to four groups receiving different intravenous lidocaine doses: 0, 1, 1.5, or 2 mg/kg.
• Anesthesia was induced with sufentanil, propofol, and suxamethonium chloride, and maintained with sevoflurane.

Main Results:

• The incidence of POV within 24 hours decreased dose-dependently with lidocaine administration (46% in 0 mg/kg group vs. 20% in 2 mg/kg group).
• Significant differences in POV incidence were observed between the highest dose group (2 mg/kg) and the control group (0 mg/kg).
• Postoperative analgesic rescue rates also decreased significantly with increasing lidocaine doses, with the 2 mg/kg group showing the lowest requirement (16%).

Conclusions:

• Intravenous lidocaine demonstrates a dose-dependent efficacy in reducing the risk of postoperative vomiting in pediatric patients undergoing tonsillectomy.
• The 2 mg/kg dose of intravenous lidocaine was associated with the lowest incidence of POV and analgesic rescue needs.
• Intravenous lidocaine can be considered a safe and effective option for preventing POV in this pediatric surgical population.