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Kokinsky E, Cassuto J, Sinclair R, Rubensson A, Nilsson K, Larsson LE. ACTA Anaesthesilogica Scandinavica 1999; 43:225-229.

Review: This was a randomized double-blind placebo-controlled study of 44 ASA 1 or 2 patients aged 9 months to 11 years, undergoing inguinal herniorraphy, during a standardized anesthetic regiment. No analgesics were administered during surgery. Patients were randomized to receive 10% lidocaine spray, a placebo aerosol, or nothing at time of wound closure. Pain was assessed by a blinded observer and the patient, on a 4 point scale, at 0, 1, 4, and 12 hours postoperatively. Plasma levels of lidocaine were also drawn 30, 60 and 90 minutes after wound closure.

Pain scores were significantly lower in the lidocaine group compared with the placebo group but not the control group at only the 1-hour interval. Supplementary paracetamol in the postoperative period was required 5/14, 10/15, and 6/15 patients in the lidocaine, placebo and control groups respectively.

Comments: This study demonstrates the inadequacy of topical lidocaine spray to provide long-term pain relief following minor surgery and reinforces the importance of supplemental analgesics in the postoperative period. It is also interesting that pain ratings and supplemental pain medications were required more frequently with the placebo group leading to the assumption that the aerosol may be responsible for considerable skin irritation. Further research comparing topical sprays (with less intrinsic irritating properties) and regional blockade with a sensitive pain scales are needed.

Reviewed by: Jeffrey Galinkin, MD
Childrens Hospital of Philadelphia