This Article Résumé de cet Article Full Text Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Reinoso-Barbero, F. Articles by Gómez-Criado, M. S. Search for Related Content PubMed PubMed Citation Articles by Reinoso-Barbero, F. Articles by Gómez-Criado, M. S.

Lidocaine with fentanyl, compared to morphine, marginally improves postoperative epidural analgesia in children

[Une combinaison de lidocaïne et de fentanyl, comparée à la morphine, améliore peu l'analgésie péridurale postopératoire chez les enfants]

Francisco Reinoso-Barbero, MD PhD^*, Barbara Saavedra, MD^*, Sara Hervilla^*, Jesús de Vicente, MD^*, Beatriz Tabarés, MD and María S. Gómez-Criado, MD

^* From the Departamentos de Anestesiología
y Farmacología Clínica Hospital Universitario "La Paz" Facultad de Medicina Universidad Autónoma de Madrid Madrid Spain

Address correspondence to: Dr. Francisco Reinoso-Barbero, Coordinador Médico de la Unidad de Dolor Infantil, Departamento de Anestesiología, Hospital Infantil "La Paz", Paseo de la Castellana 261, 28046 Madrid. Phone: +349 1727 7315; Fax: +349 1727 7033; E-mail: FREINOSO{at}santandersupernet.com

Purpose: To compare the epidural administration of fentanyl (1 µg•mL^–1) combined with lidocaine 0.4% to preservative-free morphine for postoperative analgesia and side effects in children undergoing major orthopedic surgery.

Methods: In a prospective, double-blind study, 30 children, ASA I–II, 2–16-yr-old, were randomly allocated to receive immediately after surgery either epidural F-L (epidural infusion at a rate of 0.1–0.35 mL•kg^–1•hr^–1 of 1 µg•mL^–1 of fentanyl and lidocaine 0.4%) or epidural M (bolus of 20 µg•kg^–1 of morphine in 0.5 mL•kg^–1 saline every eight hours). Both groups received 40 mg•kg^–1 of iv metamizol (dipyrone) every six hours. In the F-L Group, blood samples were taken on the second and third postoperative day to determine total lidocaine concentrations. Adequacy of analgesia using adapted pediatric pain scales (0–10 score) and side-effects were assessed every eight hours postoperatively.

Results: Resting pain scores were under 4, 95% of the time in the F-L Group and 87% of the time in the M Group (Chi square=4.674, P <0.05). The frequency of complications was very similar in both groups. The F-L Group total plasma lidocaine concentrations were directly related to the dose received, and below the toxic range in all patients.

Conclusions: Postoperative epidural fentanyl with lidocaine infusion provides slightly better analgesia than conventional bolus administration of epidural morphine. Side-effects or risk of systemic toxicity were not augmented by the addition of lidocaine to epidural opioids.