title: Continuous Lidocaine Infusions to Manage Opioid-Refractory Pain in a Series of Cancer Patients in a Pediatric Hospital.
abstract: Research on the safety and efficacy of continuous lidocaine infusions (CLIs) for the treatment of pain in the pediatric setting is limited. This article describes a series of pediatric oncology patients who received lidocaine infusions for refractory, longstanding, cancer-related pain.
  
  
  
  This is a retrospective review of patients who underwent lidocaine infusions to manage severe, opioid-refractory, cancer-related pain. Four patients ranging in age from 8 to 18 years were admitted to a pediatric hospital for their medical conditions and/or pain management. Structured chart review established demographic and diagnosis information, infusion rates, side effects, and efficacy of infusions in providing pain relief. Lidocaine bolus doses, infusion rates, serum concentrations, and subjective pain scores were analyzed.
  
  
  
  Median pain scores prior to lidocaine infusions were 8/10, falling to 2/10 at the infusion termination (P < 0.003), and rising to 3/10 in the first 24 hr after lidocaine (P < 0.029 compared to preinfusion pain). The infusions were generally well tolerated, with few side effects noted. In most cases, the improvement in pain scores persisted beyond termination of the infusion.
  
  
  
  CLIs were a helpful adjuvant in the four cases presented and may be an effective therapy for a more diverse array of refractory cancer pain. The majority of patients experienced pain relief well beyond the metabolic elimination of the lidocaine, corroborating a modulation effect on pain windup. Additional research regarding infusion rates, serum concentrations, side effects, and outpatient follow-up in a larger group of patients will provide additional insight into the role and safety of this therapy in children.
authors.affiliation: Department of Pediatric Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Gibbons
authors.affiliation: Pediatric Intensive Care Unit, C.S. Mott Children's Hospital, Ann Arbor, Michigan.
authors.forename: Andrea
authors.initials: A
authors.lastname: DeMonbrun
authors.affiliation: Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Beckman
authors.affiliation: Pediatric and Adult Palliative Care Services, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Patricia
authors.initials: P
authors.lastname: Keefer
authors.affiliation: Office of Clinical Affairs, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Deb
authors.initials: D
authors.lastname: Wagner
authors.affiliation: Department of Pediatric Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Margaret
authors.initials: M
authors.lastname: Stewart
authors.affiliation: Pediatric and Adult Palliative Care Services, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: D'Anna
authors.initials: D
authors.lastname: Saul
authors.affiliation: Department of Pediatric Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Hakel
authors.affiliation: Division of Pediatric Anesthesiology, Department of Anesthesiology, Yale University, New Haven, Connecticut.
authors.forename: My
authors.initials: M
authors.lastname: Liu
authors.affiliation: Pediatric Critical Care Medicine & Pediatric Palliative Care Service, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Matthew
authors.initials: M
authors.lastname: Niedner
mesh_terms: D000293:Adolescent; D000701:Analgesics, Opioid; D002648:Child; D004351:Drug Resistance / Q000187:drug effects*; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage* / Q000493:pharmacokinetics; D008297:Male; D009369:Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D010146:Pain / Q000188:drug therapy* / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology
chemical_list: D000701:Analgesics, Opioid; D008012:Lidocaine
keywords: cancer; chronic pain; lidocaine; pediatrics