Burns. 2025 May 27;51(7):107523. doi: 10.1016/j.burns.2025.107523. Online ahead of print.
ABSTRACT
BACKGROUND: Effective postoperative pain control in pediatric burn patients is essential for recovery. Despite advances in pain management, opioid use remains high, contributing to adverse effects and risks of dependency. Intravenous (IV) lidocaine has shown analgesic benefits in adult and pediatric postsurgical contexts but remains underexplored in burned children. This study evaluates the impact of lidocaine on opioid consumption and its safety profile in this population.
OBJECTIVE: To determine whether continuous IV lidocaine infusion reduces opioid use in pediatric burn patients during the first 72 postoperative hours, and to assess its associated adverse events or toxicity.
METHODS: A retrospective cohort study was conducted in a pediatric burn unit, including 126 postoperative patients. Data were collected on opioid and lidocaine use, demographic variables, burn characteristics, and clinical outcomes. Opioid consumption, expressed in morphine equivalent doses, was compared between patients who received lidocaine and those who did not. Safety data were also analyzed.
RESULTS: Of the 126 patients, 48.4 % were female, with a median age of 36 months (IQR: 12-72). Burns were mostly due to boiling liquids (73.8 %) and were predominantly second-degree (38.9 %). Lidocaine was administered to 32.5 % of patients, mostly those with more severe burns (p < 0.001). Patients receiving lidocaine showed significantly lower opioid consumption (median: 0.07 vs. 0.21 morphine equivalents; p < 0.05). No adverse events or toxicity were observed in patients treated with lidocaine up to 1.5 mg/kg/h for 72 hours. Multivariable analysis confirmed the association between lidocaine use and reduced opioid dosage (β = -0.13, 95 % CI: -0.21; -0.05, p = 0.01).
CONCLUSIONS: Intravenous lidocaine infusion significantly reduced opioid requirements in pediatric burn patients without causing adverse effects, supporting its use as part of a multimodal, opioid-sparing strategy. Further prospective trials are warranted to confirm its safety and efficacy.
PMID:40700802 | DOI:10.1016/j.burns.2025.107523
