Perioperative Intravenous Lidocaine Infusion Therapy as an Adjunct to Multimodal Analgesia for Adolescent Idiopathic Scoliosis Surgical Correction: A Double‐Blind Randomized Controlled Trial

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Background Posterior spinal instrumentation and fusion is a common surgical correction for adolescent idiopathic scoliosis. Preventative multimodal analgesia, including opioids, is required to minimize postoperative pain, but opioids are associated with dose‐dependent side effects that may disrupt recovery. Aims We hypothesized that the addition of 48‐h perioperative intravenous lidocaine therapy to a multimodal analgesia regimen would reduce morphine utilization. Method We conducted a double‐blinded randomized controlled trial in 10–19 years old, ASA I–III, undergoing single‐stage scoliosis correction. Participants were randomly allocated to the Intervention group (intravenous lidocaine 1 mg kg−1 bolus at anesthesia start, followed by 2 mg kg−1 h−1 infusion for 8 h, followed by 1 mg kg−1 h−1 for 40 h) or Control (normal saline). Participants received standardized perioperative multimodal analgesia, including a postoperative morphine infusion with titration rules protocolized to self‐reported pain scores. The primary outcome was 48‐h morphine utilization; secondary outcomes were median and worst pain scores, and times to first stand, first walk > 15 steps, urinary catheter removal, termination of morphine infusion, and hospital discharge. Results Data were available from 38 participants: 32 (84%) female; median (IQR) age 16.3 (14.9–17.2) years, with curve magnitude (Cobb angle) 62 (56–70) degrees. The 48‐h morphine utilization did not differ between groups: Intervention median (IQR) 0.86 (0.73–1.05) mg kg−1 versus Control 1.00 (0.77–1.18) mg kg−1; median difference −0.11 (95% CI −0.30 to 0.13) mg kg−1; p = 0.264. There were similarly no differences in morphine utilization at 12, 24, or 36 h or any secondary outcome, except the first postoperative pain score: Intervention 3/10 (1.75–5) versus Control 5/10 (3–7); median difference −2 (95% CI 0 to −3); p = 0.035. Three cases with mild symptoms of suspected local anesthetic systemic toxicity were observed in the Intervention group. Conclusions We found no evidence to support the adjunctive use of 48‐h perioperative intravenous lidocaine therapy in adolescents undergoing scoliosis correction in which effective multimodal analgesia was adopted. Trial Registration ClinicalTrials.gov identifier: NCT04069169