Study objective To evaluate the efficacy of local incisional lidocaine infusion after heart surgery.
Methods Observational prospective study including post cardiac surgery children in whom a 0,5% lidocaine elastomer was intraoperatively placed within the surgical wound. Lidocaine doses and plasma levels 48 h after administration, adverse effects, additional analgesic or sedative drugs and analgesia and sedation score were registered. All patients received intravenous metamizol and paracetamol.
Results 105 patients were analysed. Median age was 66 months, with 21% of patients under 2 years of age. The most frequent surgical interventions were: Fontan surgery (26.2%), atrial septal defects (20.4%) and ventricular septal defects (10.7%).
Median lidocaine administration duration was 58 h. 52.4% received fentanyl infusion (mean dose 1 mcg/kg/h, mean duration 24 h), 18.1% received midazolam infusion (1.5 mcg/kg/h, 8 h) and 12% received propofol (1.5 mg/kg/h, 4 h). Mean comfort score was 21.8 points and mean analgesia score was 1.9 (62% of patients required additional analgesia).
Fentanyl infusion was less often needed in patients over 2 years old than in younger patients (45.8% vs. 77.3%; p = 0.015). Midazolam infusion was also less often required in patients over 2 years old (13.3% vs 36.4%; p = 0.025).
Lidocaine plasma levels were recorded 48 h after administration in 66 patients, 46% (n = 31) were within therapeutic range (1.4–5 mcg/ml). No important side – effects attributable to lidocaine were observed.
Conclusions Incisional analgesia with lidocaine is safe and effective after cardiac surgery. Children over 2 years of age require less additional analgesia and sedation.