Plasma Lidocaine Concentrations During Intravenous Lidocaine Infusion Therapy in the Pediatric Population-A Scoping Review.

BACKGROUND

Intravenous lidocaine therapy (IVLT) is often used in perioperative multimodal analgesia due to its analgesic, anti-hyperalgesic, and anti-inflammatory effects. In adults, IVLT doses of 1-2 mg/kg/h produce plasma concentrations of 1-2 μg/mL, within the presumed therapeutic range of 1-5 μg/mL. The dose range, expected plasma concentrations, and presumed therapeutic range are not well defined in children. We aimed to review available pharmacokinetic data in pediatric patients receiving IVLT.

METHODS

We searched MEDLINE, EMBASE, and CINAHL databases for studies reporting pharmacokinetic data for IVLT in healthy 1-18-year-olds, with plasma lidocaine or metabolite levels collected post-infusion, excluding studies involving non-therapeutic infusions or children with comorbidities affecting lidocaine metabolism. Bias was assessed using validated tools. We conducted narrative data synthesis due to reporting variability and summarized plasma lidocaine and/or metabolite levels and the incidence of reported adverse events.

RESULTS

Four studies comprising 174 children were included. A study (n = 22) using a 1.5 mg/kg bolus over 30 min followed by a 1 mg/kg/h infusion for 6 h post-surgery achieved highest mean drug concentrations of 2.82 ± 0.65 μg/mL immediately following surgery. Another study (n = 46) utilized a 1.5 mg/kg bolus over 5 min followed by a 2 mg/kg/h infusion and achieved peak concentrations of 4 to < 5 μg/mL. Two studies (n = 106) utilized a 1.5 mg/kg bolus and 1.5 mg/kg/h infusion until transfer to the post-operative anesthesia care unit or six hours post-operatively achieved concentrations that were detectable and < 5 μg/mL. The only adverse event reported was a single participant who experienced transient sensory disturbances.

CONCLUSION

Existing pharmacokinetic data for pediatric IVLT is extremely limited. Reported plasma concentrations were detectable and lower than presumed toxic levels with one reported adverse event. Large-scale, multicenter research is needed to determine optimal pediatric dosing, elucidate dose response curves, and ensure safe and effective use of IVLT in the pediatric population.

TRIAL REGISTRATION: Prospective Register of Systematic Reviews (PROSPERO): CRD42025636554.