Efficiency of intravenous infusion of ketamine and lidocaine as part of multimodal analgesia in the postoperative period in children

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Abstract

BACKGROUND: The improvement of multimodal anesthesia schemes is of clinical interest because of the possibility of reducing the doses of narcotic analgesics and the earlier mobilization of patients postoperatively.

AIM: To evaluate the efficiency of intravenous infusion of ketamine and lidocaine as adjuvants for multimodal analgesia in children aged <1 year after cardiac surgery.

MATERIALS AND METHODS: A prospective single-center study included 122 children aged <1 year, who divided into three groups: group 1, postoperative pain management included a combination of fentanyl and ketamine (n = 40); group 2 (n = 41), lidocaine infusion in combination with fentanyl; group 3 (n = 41), standard analgesia (fentanyl). The median ages at the time of surgery were 4.0, 4.5, and 4.0 months in groups 1, 2, and 3, respectively. Anatomical, demographic, clinical, and laboratory parameters were analyzed before surgery and early after surgery.

RESULTS: The pain intensity according to the Neonatal Infant Pain Scale did not differ among the groups at any stage of the study. The average dose of fentanyl was twice as high in group 3 at 1.6 mcg/kg/h compared with 0.5 mcg/kg/h in group 1 and 0.6 mcg/kg/h in group 2. Group 2 had a shorter duration of mechanical ventilation in an intergroup comparison. The side effects of lidocaine were not recorded, and hypersalivation was noted in 35% of the patients who were treated with ketamine.

CONCLUSIONS: Ketamine infusion as an adjuvant to multimodal analgesia provides an adequate analgesic effect without a significant effect on hemodynamics and allows a reduction in the dose of opioids. The intravenous infusion of lidocaine as a component of multimodal analgesia after cardiac surgery in children has an additional opioid-sparing effect and reduces the mechanical ventilation time. The use of lidocaine at a dose of 1 mg/kg/h is not accompanied by side effects.

About the authors

Vladlen V. Bazylev

Federal Center of cardiovascular surgery

Email: cardio58@yandex.ru
ORCID iD: 0000-0001-6089-9722
SPIN-code: 3153-8025

Dr. Sci. (Med.), Professor, Chief Physician

Russian Federation, Penza

Klara T. Shcheglova

Federal Center of cardiovascular surgery

Author for correspondence.
Email: klara-tamir@yandex.ru
ORCID iD: 0000-0001-8468-4806
SPIN-code: 5450-6674

Anesthesiologist-intensivist

Russian Federation, Penza

Maxim P. Chuprov

Federal Center of cardiovascular surgery

Email: maks13chup@bk.ru
ORCID iD: 0000-0002-4908-8010
SPIN-code: 8970-1397

Anesthesiologist-intensivist

Russian Federation, Penza

Anton I. Magilevets

Federal Center of cardiovascular surgery

Email: citadel1943@inbox.ru
ORCID iD: 0000-0003-0586-5671
SPIN-code: 8965-1264

Head of the Department of Anesthesiology and Intensive Care No. 2

Russian Federation, Penza

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Supplementary files

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2. Fig. 1. Structure of congenital heart defects in the three groups. ТФ — tetralogy of Fallot; ДОС — double outlet vessels; ПЖ — right ventricle; АВК — atrioventricular canal; ЕЖС — single ventricle of the heart; ВПС — congenital heart disease

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3. Fig. 2. Dynamics of pain syndrome intensity according to the Neonatal Infant Pain Scale

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4. Fig. 3. Hemodynamic parameters in the postoperative period in the three groups of patients

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5. Fig. 4. Postoperative dynamics of changes in the laboratory indicators of stress response in the three groups of patients

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