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Postoperative use and early discontinuation of intravenous lidocaine in spine patients

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Abstract

Purpose

Our institution employs a multimodal approach to manage postoperative pain after spine surgery. It involves continuous intravenous (IV) lidocaine until the morning of postoperative day two. This study aimed to determine the rate and reasons for early discontinuation of IV lidocaine in our spine patients.

Methods

We conducted a retrospective chart review and included pediatric patients who underwent ≥ 3-level spine surgery and received postoperative IV lidocaine from November 2019 to September 2022. For each case, we recorded the side effects of IV lidocaine, adverse events, time to discontinuation, and discontinuation rate. Subsequently, we used the same methodology to generate an adult cohort for comparison.

Results

We included 52 pediatric (18M:34F) and 50 (21M:29F) adult patients. The pediatric cohort’s mean age was 14 years (8–18), and BMI 23.9 kg/m2 (13.0–42.8). The adult cohort’s mean age was 61 years (29–82), and BMI 28.8 kg/m2 (17.2–44.1). IV lidocaine was discontinued prematurely in 21/52 (40.4%) of the pediatric cases and 26/50 (52.0%) of the adult cases (RR = 0.78, p = 0.2428). The side effects noted in the pediatric cases vary, including numbness, visual disturbance, and obtundation, but no seizures. The most common adverse events were fever and motor dysfunction.

Conclusion

The early discontinuation rate of IV lidocaine use after spine surgery for children in our institution does not differ significantly from that of adults. The nature of the side effects and the reasons for discontinuation between the groups were similar. Thus, the safety profile of IV lidocaine for pediatric spine patients is comparable to adults.

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Acknowledgements

We thank Michael D. Evans, MS, for his work on the statistical analysis for this project.

Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN, 55455, USA

    Paul Brian O. Soriano, Jason J. Haselhuhn, Dana B. Swanson, Kenneth J. Holton & David W. Polly Jr.

  2. Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA

    Joseph C. Resch & Gwenyth A. Fischer

  3. Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA

    David W. Polly Jr.

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  1. Paul Brian O. Soriano
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Contributions

PBOS, JJH, JCR, GAF, DBS, KJH, DWP: Made substantial contributions to the conception and design of the work, and the acquisition, analysis, and interpretation of data. Revised the work critically for important intellectual content. Approved the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding authors

Correspondence to Jason J. Haselhuhn or David W. Polly Jr..

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Conflict of interest

DP declares consulting fees from Globus Medical and Alexion; institutional grant/research support from Medtronic and Mizuho OSI; consulting fees, royalties, and honoraria from SI Bone; and royalties/other financial or material support from Springer. PS, JH, JR, GF, DS, and KH declare no financial conflicts. The authors did not receive support from any organization for the submitted work.

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This study was approved by the University of Minnesota Institutional Review Board.

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Soriano, P.B.O., Haselhuhn, J.J., Resch, J.C. et al. Postoperative use and early discontinuation of intravenous lidocaine in spine patients. Spine Deform 12, 141–148 (2024). https://doi.org/10.1007/s43390-023-00753-3

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