Int J Clin Pediatr

International Journal of Clinical Pediatrics, ISSN 1927-1255 print, 1927-1263 online, Open Access

Article copyright, the authors; Journal compilation copyright, Int J Clin Pediatr and Elmer Press Inc

Journal website https://ijcp.elmerpub.com

Original Article

Volume 14, Number 2, October 2025, pages 37-43

Preliminary Experience With a Lidocaine Infusion as an Adjunct During Acute Pain Management Related to Medical Illnesses in Pediatric Patients

**Table 1.** Demographic and Clinical Characteristics
Characteristics	Frequency (%)	Median (IQR)
The data are listed as number (percentages) or median (IQR). ^aAll data are reported per encounter. ^bLidocaine infusion was stopped on day 3 due to lack of effect. Pain improved after engraftment. BMT: bone marrow transplant; CML: chronic myelogenous leukemia; IQR: interquartile range.
Number of patients	15
Total number of lidocaine infusion encounters^a	46
Age		14 (13, 20)
Height (cm)		160.7 (151.9, 169.8)
Weight (kg)		57.9 (54.1, 74.4)
Gender
Female	29 (63.0)
Male	17 (37.0)
Race and ethnicity
Asian	1 (2.2)
Non-Hispanic Black	43 (93.5)
Non-Hispanic White	2 (4.3)
Primary disease condition
CML - oral mucositis pain (post-BMT)^b	1 (2.2)
Factor XIII deficiency - severe myalgia related to factor infusion	2 (4.3)
Sickle cell disease - sickle cell pain crisis	43 (93.5)
Hospital length of stay (days)		7 (5, 12)

Table 1. Demographic and Clinical Characteristics

Characteristics

Frequency (%)

Median (IQR)

The data are listed as number (percentages) or median (IQR). ^aAll data are reported per encounter. ^bLidocaine infusion was stopped on day 3 due to lack of effect. Pain improved after engraftment. BMT: bone marrow transplant; CML: chronic myelogenous leukemia; IQR: interquartile range.

Number of patients

Total number of lidocaine infusion encounters^a

Age

14 (13, 20)

Height (cm)

160.7 (151.9, 169.8)

Weight (kg)

57.9 (54.1, 74.4)

Gender

Female

29 (63.0)

Male

17 (37.0)

Race and ethnicity

Asian

1 (2.2)

Non-Hispanic Black

43 (93.5)

Non-Hispanic White

2 (4.3)

Primary disease condition

CML - oral mucositis pain (post-BMT)^b

1 (2.2)

Factor XIII deficiency - severe myalgia related to factor infusion

2 (4.3)

Sickle cell disease - sickle cell pain crisis

43 (93.5)

Hospital length of stay (days)

7 (5, 12)

**Table 2.** Lidocaine Infusion Characteristics
Variables	Frequency (%)	Median (IQR)
The data are listed as number (percentages) or median (IQR). All data are reported per encounter (n = 46). ^aOne encounter received two boluses on different days. IQR: interquartile range.
Total number of lidocaine infusion encounters	46
Infusion duration (days)
1 - 2	3 (6.5)
3 - 5	17 (37.0)
6 - 10	18 (39.1)
> 10	8 (17.4)
Total lidocaine infusion days	310
Lidocaine infusion rate over all days (mg/kg/h)		1.0 (1.0, 1.5)
Lidocaine infusion rate (mg/kg/h)
< 1.0	9 (19.6)
1.0 to 1.5	32 (69.6)
> 1.5 to 2.5	5 (10.9)
Encounters with lidocaine bolus administered	19 (41.3)
Total number of lidocaine boluses administered^a	20
Lidocaine bolus dose (mg/kg)		2.0 (1.2, 2.0)

Table 2. Lidocaine Infusion Characteristics

Variables

Frequency (%)

Median (IQR)

The data are listed as number (percentages) or median (IQR). All data are reported per encounter (n = 46). ^aOne encounter received two boluses on different days. IQR: interquartile range.

Total number of lidocaine infusion encounters

Infusion duration (days)

1 - 2

3 (6.5)

3 - 5

17 (37.0)

6 - 10

18 (39.1)

> 10

8 (17.4)

Total lidocaine infusion days

310

Lidocaine infusion rate over all days (mg/kg/h)

1.0 (1.0, 1.5)

Lidocaine infusion rate (mg/kg/h)

< 1.0

9 (19.6)

1.0 to 1.5

32 (69.6)

> 1.5 to 2.5

5 (10.9)

Encounters with lidocaine bolus administered

19 (41.3)

Total number of lidocaine boluses administered^a

Lidocaine bolus dose (mg/kg)

2.0 (1.2, 2.0)

**Table 3.** Adverse Events During Lidocaine Infusion
Variables	Number (%)
The data are listed as number (percentages). All data are reported per encounter (n = 46). Percentages for the type of AE are based on the nine affected encounters.
Infusion days with adverse events (AEs)	11 (3.5)
Encounters with AEs	9 (19.6)
Types of AE in affected encounters
Anxiety	1 (11.1)
Dizziness	3 (33.3)
Hallucinations	1 (11.1)
Hypotension	4 (44.4)
Frequency of AEs per encounter
None	37 (80.4)
One	8 (17.4)
Three	1 (2.2)
Encounters with infusion rate changed due to AEs	6 (13.0)

Table 3. Adverse Events During Lidocaine Infusion

Variables

Number (%)

The data are listed as number (percentages). All data are reported per encounter (n = 46). Percentages for the type of AE are based on the nine affected encounters.

Infusion days with adverse events (AEs)

11 (3.5)

Encounters with AEs

9 (19.6)

Types of AE in affected encounters

Anxiety

1 (11.1)

Dizziness

3 (33.3)

Hallucinations

1 (11.1)

Hypotension

4 (44.4)

Frequency of AEs per encounter

None

37 (80.4)

One

8 (17.4)

Three

1 (2.2)

Encounters with infusion rate changed due to AEs

6 (13.0)

**Table 4.** Summary of Pediatric Reports Using Lidocaine Infusions
Author and reference	Patient characteristics	Clinical setting	Lidocaine dosing and duration	Outcomes and AEs
IV: intravenous; PICU: pediatric intensive care unit; AE: adverse effects; OR: operating room.
Couser et al, 2023 [3]	168 patients (1 - 21 years). Postoperative - spinal fusion (n = 142), other procedures (n = 26)	OR to inpatient ward	Optional bolus 1 mg/kg, followed by infusion 1 mg/kg/h intraoperatively (mean duration 329 min). Postoperative infusion administered in 86% of patients for 1 - 3 days.	Effective pain control (scores 2 - 3/10) while receiving opioids. Mostly minor AEs (confusion, blurred vision, hallucinations); causality cannot be established as these patients received additional medications.
Nathan et al, 2005 [4]	11-year-old with erythromelalgia.	PICU	1 mg/kg/h, titrated to maintain serum levels at 2 - 5 µg/mL over 4 days.	Pain episodes decreased in intensity and frequency from 20/day to 1/day. Later transitioned to oral mexiletine. No AEs noted.
Mooney et al, 2014 [10]	15 patients (12 - 20 years) with intractable headaches, neuropathic pain, and other chronic pain.	Started in PICU, continued in outpatient infusion center.	40 - 60 µg/kg/min typically 2 - 6 h per session; average 4 sessions/patient.	Most patients reported pain reduction, especially with baseline pain scores of 6 of 10. Minimal or no AEs reported.
Lo et al, 2020 [11]	8-year-old with inoperable supratentorial ependymoma and severe headaches.	PICU	0.5 - 2 mg/kg/h over 11 days.	Dramatic improvement by day 3 at 1.5 mg/kg/h. Headache returned quickly when titrated down. No AEs described.
Lemming et al, 2019 [12]	50 patients (2 - 17 years). Postoperative administration.	Perioperative. Started in the OR (80%) or PICU/intermediate care unit (20%).	Mean start rate 13.6 ± 6.5 µg/kg/min. Mean infusion 15.2 ± 6.3 µg/kg/min. Mean duration of infusion 30.6 ± 22 h	Focus was on AEs. Encountered paresthesias (10%), visual disturbances (4%). Average onset time 16.2 ± 15.2 h. Overall, well tolerated.
Gupta et al, 2025 [13]	Systematic review/meta-analysis; 7 studies, 415 patients (6 months - 18 years). Healthy, undergoing surgery.	Perioperative	IV bolus 1 - 1.5 mg/kg followed by infusion 1.5 - 2 mg/kg/h. Continued for 6 h postoperatively (4 studies), intraoperatively only (3 studies).	Well tolerated. The primary outcome was 24 h postoperative opioid use. Low quality evidence of reduced opioid use with lidocaine.
Wallace et al, 1997 [14]	5 patients (4 - 7 years) with neuroblastoma undergoing immunotherapy.	Information not provided	Daily bolus 2 mg/kg, followed by infusion 1 mg/kg/h for 7 h (5 h during antibody infusion + 2 h post). Repeated 4 days/month.	Reduced opioid use. As lidocaine plasma levels decreased, morphine use increased. Emesis on day 4 at peak plasma lidocaine level.
Massey et al, 2002 [15]	5-year-old with metastatic retinoblastoma (palliative).	Initiated inpatient with anesthesiology supervision, transitioned to home care.	35 to 50 µg/kg/min over 4 days inpatient, continued at home, titrated to a maximum of 63 µg/kg/min for 2 months.	Long-term use in a terminally ill patient. No severe, or neurotoxic or cardiovascular AEs encountered. Successfully managed at home until death (2 months).
Gibbons et al, 2016 [16]	4 patients (8 - 18 years), refractory cancer pain.	Started in PICU, continued in the general care unit.	Bolus 1 mg/kg (71% of infusions), followed by infusion at 15 - 50 µg/kg/min. Median duration 2.15 days (range 5 h - 17 days)	Well tolerated, reduced pain scores even 24 h post-infusion. Pain scores improved as serum lidocaine concentrations increased (weak correlation). AEs in 3 patients (vision changes, hallucinations, paresthesia). No major AEs.
Luo et al, 2025 [17]	Prospective, randomized, blinded study in a cohort of 38 adolescents (10 - 19 years) for scoliosis surgery	Started in the OR and continued for a total of 48 h postoperatively on the inpatient ward.	Bolus of 1 mg/kg intraoperatively followed by 2 mg/kg/h for 8 h and then 1 mg/kg/h for 40 h.	No differences in postoperative morphine utilization, postoperative pain scores or any of the secondary outcomes.
Agbakwuru et al, 2025 [18]	Retrospective study of 174 lidocaine infusions in a cohort of 72 patients with sickle cell disease.	Lidocaine infusion started on the inpatient ward, generally within 24 h of admission.	Hospital-based pathway and protocol for use of lidocaine for patients with acute pain related to sickle cell disease. Infusion started at 1 - 2 mg/kg/h (ideal body weight) for 48 h. Lidocaine serum level drawn at 24 h.	No serious toxicities noted. The majority of recipients (82.2%) chose to receive lidocaine infusion during subsequent admissions. Authors recommend a prospective trial to determine efficacy.

Table 4. Summary of Pediatric Reports Using Lidocaine Infusions

Author and reference

Patient characteristics

Clinical setting

Lidocaine dosing and duration

Outcomes and AEs

IV: intravenous; PICU: pediatric intensive care unit; AE: adverse effects; OR: operating room.

Couser et al, 2023 [3]

168 patients (1 - 21 years). Postoperative - spinal fusion (n = 142), other procedures (n = 26)

OR to inpatient ward

Optional bolus 1 mg/kg, followed by infusion 1 mg/kg/h intraoperatively (mean duration 329 min). Postoperative infusion administered in 86% of patients for 1 - 3 days.

Effective pain control (scores 2 - 3/10) while receiving opioids. Mostly minor AEs (confusion, blurred vision, hallucinations); causality cannot be established as these patients received additional medications.

Nathan et al, 2005 [4]

11-year-old with erythromelalgia.

PICU

1 mg/kg/h, titrated to maintain serum levels at 2 - 5 µg/mL over 4 days.

Pain episodes decreased in intensity and frequency from 20/day to 1/day. Later transitioned to oral mexiletine. No AEs noted.

Mooney et al, 2014 [10]

15 patients (12 - 20 years) with intractable headaches, neuropathic pain, and other chronic pain.

Started in PICU, continued in outpatient infusion center.

40 - 60 µg/kg/min typically 2 - 6 h per session; average 4 sessions/patient.

Most patients reported pain reduction, especially with baseline pain scores of 6 of 10. Minimal or no AEs reported.

Lo et al, 2020 [11]

8-year-old with inoperable supratentorial ependymoma and severe headaches.

PICU

0.5 - 2 mg/kg/h over 11 days.

Dramatic improvement by day 3 at 1.5 mg/kg/h. Headache returned quickly when titrated down. No AEs described.

Lemming et al, 2019 [12]

50 patients (2 - 17 years). Postoperative administration.

Perioperative. Started in the OR (80%) or PICU/intermediate care unit (20%).

Mean start rate 13.6 ± 6.5 µg/kg/min. Mean infusion 15.2 ± 6.3 µg/kg/min. Mean duration of infusion 30.6 ± 22 h

Focus was on AEs. Encountered paresthesias (10%), visual disturbances (4%). Average onset time 16.2 ± 15.2 h. Overall, well tolerated.

Gupta et al, 2025 [13]

Systematic review/meta-analysis; 7 studies, 415 patients (6 months - 18 years). Healthy, undergoing surgery.

Perioperative

IV bolus 1 - 1.5 mg/kg followed by infusion 1.5 - 2 mg/kg/h. Continued for 6 h postoperatively (4 studies), intraoperatively only (3 studies).

Well tolerated. The primary outcome was 24 h postoperative opioid use. Low quality evidence of reduced opioid use with lidocaine.

Wallace et al, 1997 [14]

5 patients (4 - 7 years) with neuroblastoma undergoing immunotherapy.

Information not provided

Daily bolus 2 mg/kg, followed by infusion 1 mg/kg/h for 7 h (5 h during antibody infusion + 2 h post). Repeated 4 days/month.

Reduced opioid use. As lidocaine plasma levels decreased, morphine use increased. Emesis on day 4 at peak plasma lidocaine level.

Massey et al, 2002 [15]

5-year-old with metastatic retinoblastoma (palliative).

Initiated inpatient with anesthesiology supervision, transitioned to home care.

35 to 50 µg/kg/min over 4 days inpatient, continued at home, titrated to a maximum of 63 µg/kg/min for 2 months.

Long-term use in a terminally ill patient. No severe, or neurotoxic or cardiovascular AEs encountered. Successfully managed at home until death (2 months).

Gibbons et al, 2016 [16]

4 patients (8 - 18 years), refractory cancer pain.

Started in PICU, continued in the general care unit.

Bolus 1 mg/kg (71% of infusions), followed by infusion at 15 - 50 µg/kg/min. Median duration 2.15 days (range 5 h - 17 days)

Well tolerated, reduced pain scores even 24 h post-infusion. Pain scores improved as serum lidocaine concentrations increased (weak correlation). AEs in 3 patients (vision changes, hallucinations, paresthesia). No major AEs.

Luo et al, 2025 [17]

Prospective, randomized, blinded study in a cohort of 38 adolescents (10 - 19 years) for scoliosis surgery

Started in the OR and continued for a total of 48 h postoperatively on the inpatient ward.

Bolus of 1 mg/kg intraoperatively followed by 2 mg/kg/h for 8 h and then 1 mg/kg/h for 40 h.

No differences in postoperative morphine utilization, postoperative pain scores or any of the secondary outcomes.

Agbakwuru et al, 2025 [18]

Retrospective study of 174 lidocaine infusions in a cohort of 72 patients with sickle cell disease.

Lidocaine infusion started on the inpatient ward, generally within 24 h of admission.

Hospital-based pathway and protocol for use of lidocaine for patients with acute pain related to sickle cell disease. Infusion started at 1 - 2 mg/kg/h (ideal body weight) for 48 h. Lidocaine serum level drawn at 24 h.

No serious toxicities noted. The majority of recipients (82.2%) chose to receive lidocaine infusion during subsequent admissions. Authors recommend a prospective trial to determine efficacy.