{"id":3524,"date":"2023-06-29T22:42:32","date_gmt":"2023-06-29T22:42:32","guid":{"rendered":"https:\/\/paeder.com\/23-04-blog-lidocaine"},"modified":"2024-09-29T14:28:31","modified_gmt":"2024-09-29T14:28:31","slug":"23-04-blog-lidocaine","status":"publish","type":"post","link":"https:\/\/paeder.com\/en\/23-04-blog-lidocaine","title":{"rendered":"23-04 Blog Lidocaine"},"content":{"rendered":"<div class='flex_column av-apdylb-9380a1802d51f7ca65c8afd6c8860690 av_one_fifth  avia-builder-el-0  el_before_av_three_fifth  avia-builder-el-first  first flex_column_div '     ><\/div>\n<div class='flex_column av-9qj8u7-8854735d90ba93e19c0f556575e187f7 av_three_fifth  avia-builder-el-1  el_after_av_one_fifth  el_before_av_one_fifth  flex_column_div '     ><p>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-ljhqd5wr-fa23fd114b8f80890223922134d51c9d\">\n.avia-image-container.av-ljhqd5wr-fa23fd114b8f80890223922134d51c9d img.avia_image{\nbox-shadow:none;\n}\n.avia-image-container.av-ljhqd5wr-fa23fd114b8f80890223922134d51c9d .av-image-caption-overlay-center{\ncolor:#ffffff;\n}\n<\/style>\n<div  class='avia-image-container av-ljhqd5wr-fa23fd114b8f80890223922134d51c9d av-styling- avia-align-center  avia-builder-el-2  el_before_av_hr  avia-builder-el-first '   itemprop=\"image\" itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/ImageObject\" ><div class=\"avia-image-container-inner\"><div class=\"avia-image-overlay-wrap\"><img decoding=\"async\" class='wp-image-3540 avia-img-lazy-loading-not-3540 avia_image ' src=\"https:\/\/paeder.com\/wp-content\/uploads\/2023\/06\/Header-Lidocain-1920-x-761.jpg\" alt='' title='Header Lidocain 1920 x 761'  height=\"761\" width=\"1920\"  itemprop=\"thumbnailUrl\" srcset=\"https:\/\/paeder.com\/wp-content\/uploads\/2023\/06\/Header-Lidocain-1920-x-761.jpg 1920w, https:\/\/paeder.com\/wp-content\/uploads\/2023\/06\/Header-Lidocain-1920-x-761-300x119.jpg 300w, https:\/\/paeder.com\/wp-content\/uploads\/2023\/06\/Header-Lidocain-1920-x-761-1030x408.jpg 1030w, https:\/\/paeder.com\/wp-content\/uploads\/2023\/06\/Header-Lidocain-1920-x-761-768x304.jpg 768w, https:\/\/paeder.com\/wp-content\/uploads\/2023\/06\/Header-Lidocain-1920-x-761-1536x609.jpg 1536w, https:\/\/paeder.com\/wp-content\/uploads\/2023\/06\/Header-Lidocain-1920-x-761-1500x595.jpg 1500w, https:\/\/paeder.com\/wp-content\/uploads\/2023\/06\/Header-Lidocain-1920-x-761-705x279.jpg 705w, https:\/\/paeder.com\/wp-content\/uploads\/2023\/06\/Header-Lidocain-1920-x-761-450x178.jpg 450w, https:\/\/paeder.com\/wp-content\/uploads\/2023\/06\/Header-Lidocain-1920-x-761-600x238.jpg 600w\" sizes=\"(max-width: 1920px) 100vw, 1920px\" \/><\/div><\/div><\/div><br \/>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-708skv-11502c77cf651089170e6f24b09da6cb\">\n#top .hr.hr-invisible.av-708skv-11502c77cf651089170e6f24b09da6cb{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-708skv-11502c77cf651089170e6f24b09da6cb hr-invisible  avia-builder-el-3  el_after_av_image  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div><br \/>\n<section  class='av_textblock_section av-ljhtwbfa-1c4e87de9bfd9c8e69d0b70c38c00ce1'  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><p style=\"text-align: right;\">April 18, 2023<\/p>\n<\/div><\/section><br \/>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-5tsl5b-9e098b2d65e2b009ea2bb1175d2c6feb\">\n#top .av-special-heading.av-5tsl5b-9e098b2d65e2b009ea2bb1175d2c6feb{\npadding-bottom:10px;\ncolor:#fc0001;\n}\nbody .av-special-heading.av-5tsl5b-9e098b2d65e2b009ea2bb1175d2c6feb .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n.av-special-heading.av-5tsl5b-9e098b2d65e2b009ea2bb1175d2c6feb .special-heading-inner-border{\nborder-color:#fc0001;\n}\n.av-special-heading.av-5tsl5b-9e098b2d65e2b009ea2bb1175d2c6feb .av-subheading{\nfont-size:15px;\n}\n<\/style>\n<div  class='av-special-heading av-5tsl5b-9e098b2d65e2b009ea2bb1175d2c6feb av-special-heading-h2 custom-color-heading  avia-builder-el-5  el_after_av_textblock  el_before_av_hr '><h2 class='av-special-heading-tag'  itemprop=\"headline\"  >Lidocaine &#8211; unsuitable and dangerous as an analgesic!<\/h2><div class=\"special-heading-border\"><div class=\"special-heading-inner-border\"><\/div><\/div><\/div><br \/>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-25tfhb-8bf105cf0665794efba5799b5933006b\">\n#top .hr.hr-invisible.av-25tfhb-8bf105cf0665794efba5799b5933006b{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-25tfhb-8bf105cf0665794efba5799b5933006b hr-invisible  avia-builder-el-6  el_after_av_heading  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div><br \/>\n<section  class='av_textblock_section av-ljhqdget-89f1e93b26ce1815e973dfb894584fe6'  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><p class=\"EndNoteBibliography\"><span style=\"color: #333333;\"><strong>Lidocaine has also gained some popularity as an analgesic in pediatric medicine, although there is no scientific basis for this. At the outset, a very important observation: the therapeutic range of lidocaine is very narrow.<\/strong><\/span><\/p>\n<h3><span style=\"color: #333333;\"><strong>Misinformation through video  <\/strong><\/span><\/h3>\n<p class=\"EndNoteBibliography\"><span style=\"color: #333333;\">While therapeutic plasma concentrations are 2.5-3.5 mcg\/ml, toxicity must be expected at 5 mcg\/ml [1]. This means that with this drug in particular, dosing errors are very dangerous. As in the fatal case of a seven-month-old infant who was given lidocaine in an intraosseous needle<a style=\"color: #333333;\" href=\"https:\/\/www.focus.de\/regional\/hamburg\/staatsanwaltschaft-ermittelt-sieben-monate-altes-kind-starb-bei-rettungseinsatz-eltern-zeigen-den-behandelnden-notarzt-an_id_24285671.html\" target=\"_blank\" rel=\"noopener\">(go here to Focus article<\/a>).<\/span><\/p>\n<p class=\"EndNoteBibliography\"><span style=\"color: #333333;\">It is particularly tragic that the desired analgesia for drug administration via an intraosseous needle cannot be achieved with it, as clinical everyday life in the children&#8217;s hospital shows. The reason for the popularity of this practice was probably a video published by the &#8220;New England Journal of Medicine&#8221; in 2011 [2]. Even in the same issue of NEJM [3], it was pointed out that there was no evidence for the efficacy described here.<\/span><\/p>\n<p class=\"EndNoteBibliography\"><span style=\"color: #333333;\">Nevertheless, the European Resucitation Council guidelines [4] and a German S1 guideline recommend analgesia with lidocaine for intraosseous needles [5]. Both also offer no evidence of efficacy, which remains absent to this day. This is also stated by the Drug Commission of the German Medical Association (Akd\u00c4), which literally writes the following in the German Medical Journal (and thus has a duty of care for the German medical profession!) [6]: <i>&#8220;In the opinion of the Akd\u00c4, the concept of intraosseous pretreatment with lidocaine to avoid pain before intraosseous administration of drugs and volume replacement in pediatric patients should be rejected, as the active substance can be dangerous due to its unpredictable systemic effect. There are also alternatives to pain therapy with opioids such as morphine or fentanyl.&#8221;<\/i> It is to be hoped that the guidelines mentioned will receive an erratum and be corrected as quickly as possible!<\/span><\/p>\n<h3 class=\"EndNoteBibliography\"><span style=\"color: #333333;\"><strong>Ineffective and potentially life-threatening!<\/strong><\/span><\/h3>\n<p class=\"EndNoteBibliography\"><span style=\"color: #333333;\">It has also not been shown to be effective as a systemic analgesic when administered intravenously &#8211; again, there are safety concerns [1,7]. The only indication for lidocaine in pediatric emergency medicine is for severe ventricular arrhythmias with i.v. administration of 1 mg\/kg bw as an alternative to amiodarone &#8220;if the user is experienced in its use&#8221; [4].<\/span><\/p>\n<p class=\"EndNoteBibliography\"><span style=\"color: #333333;\">Therefore, the Pediatric Emergency Use Guide (P\u00e4dNFL) only specifies this exact use for lidocaine. Safety is often also knowing what NOT to do!<\/span><\/p>\n<\/div><\/section><br \/>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-2llmq7-e47e5405a9f567529cb63a2605857ea7\">\n#top .hr.hr-invisible.av-2llmq7-e47e5405a9f567529cb63a2605857ea7{\nheight:40px;\n}\n<\/style>\n<div  class='hr av-2llmq7-e47e5405a9f567529cb63a2605857ea7 hr-invisible  avia-builder-el-8  el_after_av_textblock  el_before_av_button '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div><br \/>\n<div  class='avia-button-wrap av-ljhtg6lw-3a8417315c163ddd35717afb3e22bea1-wrap avia-button-center  avia-builder-el-9  el_after_av_hr  el_before_av_hr ' >\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-ljhtg6lw-3a8417315c163ddd35717afb3e22bea1\">\n#top #wrap_all .avia-button.av-ljhtg6lw-3a8417315c163ddd35717afb3e22bea1{\nfont-size:20px;\nbackground-color:#ffcd00;\nborder-color:#ffcd00;\ncolor:#444444;\n-webkit-transition:all 0.4s ease-in-out;\n-moz-transition:all 0.4s ease-in-out;\n-ms-transition:all 0.4s ease-in-out;\n-o-transition:all 0.4s ease-in-out;\ntransition:all 0.4s ease-in-out;\n}\n<\/style>\n<a href='https:\/\/paeder.com\/shop'  class='avia-button av-ljhtg6lw-3a8417315c163ddd35717afb3e22bea1 avia-icon_select-yes-left-icon avia-size-large avia-position-center' ><span class='avia_button_icon avia_button_icon_left' aria-hidden='true' data-av_icon='\ue859' data-av_iconfont='entypo-fontello'><\/span><span class='avia_iconbox_title' >Order the P\u00e4dNFL\/P\u00e4dOP here<\/span><\/a><\/div><br \/>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-ljirgbou-b7ee69f6f0240e09956a5c774e1f75d5\">\n#top .hr.hr-invisible.av-ljirgbou-b7ee69f6f0240e09956a5c774e1f75d5{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-ljirgbou-b7ee69f6f0240e09956a5c774e1f75d5 hr-invisible  avia-builder-el-10  el_after_av_button  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div><br \/>\n<section  class='av_textblock_section av-4bz7rz-e25412b4706924f161e2260a5b621bf7'  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><p class=\"EndNoteBibliography\"><strong>Literature:<\/strong><\/p>\n<ol>\n<li class=\"EndNoteBibliography\"><span lang=\"EN-US\">Hall EA, Sauer HE, Davis MS et al. Lidocaine Infusions for Pain Management in Pediatrics. Paediatric drugs 2021; 23: 349-359, DOI: 10.1007\/s40272-021-00454-2.<\/span><\/li>\n<li class=\"EndNoteBibliography\"><span lang=\"EN-US\">Nagler J, Krauss B. Intraosseous Catheter Placement in Children. New England Journal of Medicine 2011; 364: e14, DOI: 10.1056\/NEJMvcm0900916.<\/span><\/li>\n<li class=\"EndNoteBibliography\"><span lang=\"EN-US\">Thim T, Lofgren B, Grove EL. Intraosseous catheter placement in children. N Engl J Med 2011; 364: 2171; author reply 2171, DOI: 10.1056\/NEJMc1103310#SA1.<\/span><\/li>\n<li class=\"EndNoteBibliography\"><span lang=\"EN-US\">Van de Voorde P, Turner NM, Djakow J et al. European Resuscitation Council Guidelines 2021: Paediatric Life Support. Resuscitation 2021; 161: 327-387, DOI: 10.1016\/j.resuscitation.2021.02.015.<\/span><\/li>\n<li class=\"EndNoteBibliography\"><span lang=\"EN-US\">Helm M, Bernhard M, B\u00f6ttiger BW et al. S1 Guideline: The intraosseous infusion in emergency medicine. Anaesthesiol Intensivmed 2018; 59: 667-677,  <\/span><\/li>\n<li class=\"EndNoteBibliography\"><span lang=\"EN-US\">Akd\u00c4. &#8220;From the UAW Database&#8221; Intraosseous administration of lidocaine for pain management in pediatric patients &#8211; an inappropriate, potentially dangerous off-label recommendation. Deutsches Aerzteblatt 2022; 119: A2157-A2158,<\/span><\/li>\n<li class=\"EndNoteBibliography\"><span lang=\"EN-US\">Heath C, Hii J, Thalayasingam P et al. Perioperative intravenous lidocaine use in children. Paediatr Anaesth 2022, DOI: 10.1111\/pan.14608.<\/span><\/li>\n<\/ol>\n<\/div><\/section><br \/>\n<div  class='av-social-sharing-box av-ljsrxz03-b10f5be4fda72ff8c3df359342f0be67 av-social-sharing-box-default  avia-builder-el-12  el_after_av_textblock  el_before_av_hr  av-social-sharing-box-fullwidth'><div class=\"av-share-box\"><h5 class='av-share-link-description av-no-toc '>Share post<\/h5><ul class=\"av-share-box-list noLightbox\"><li class='av-share-link av-social-link-facebook' ><a target=\"_blank\" aria-label=\"Share on Facebook\" href='https:\/\/www.facebook.com\/sharer.php?u=https:\/\/paeder.com\/en\/23-04-blog-lidocaine&#038;t=23-04%20Blog%20Lidocaine' aria-hidden='false' data-av_icon='\ue8f3' data-av_iconfont='entypo-fontello' title='' data-avia-related-tooltip='Share on Facebook' rel=\"noopener\"><span class='avia_hidden_link_text'>Share on Facebook<\/span><\/a><\/li><li class='av-share-link av-social-link-twitter' ><a target=\"_blank\" aria-label=\"Share on Twitter\" 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