**2.14. BCCH experience of lidocaine infusions for chronic pain**

Second infusion:

Third infusion:

toxicity.

infusion/s.

• Location and monitors as for initial infusion

• Infusion increased to 7 mg/kg over 90 min

• Time between infusions: usually a month

• Total dose: 8 mg/kg (loading dose + infusion)

• Infusion increased to 9 mg/kg over 90–120 min • Total dose: 10 mg/kg (loading dose + infusion)

**2.13. Continuous subcutaneous lidocaine therapy**

1. Child/youth is fully integrated into multi-disciplinary care

3. The pain is not amenable to the use of topical lidocaine

4. Child/youth has no contra-indication to the use of systemic lidocaine.

2. Their pain syndrome is lidocaine-responsive.

If IVLT is effective or partially effective, the patient can be started on a 5-day continuous subcutaneous (SC) infusion if pain is hampering for restoration of function/physical activity (**Table 5**). SC infusions use an elastomer pump which delivers a set volume of lidocaine per hour (depending on the pump used), usually 5 ml/h, which approximately equates with 2 mg/kg/h using 2% lidocaine for a patient who is 50 kg. The infusion only runs whilst the patient is awake so that they can self-report any symptoms, which may suggest lidocaine

5. Child/youth capable of verbally communicating analgesic response and symptoms of early local anaesthetic toxicity. 6. The child has previously experienced a lidocaine infusion in a high acuity environment without complication. 7. The child/youth demonstrates some improvement in functional activity following on from previous lidocaine

9. Appropriate homecare support, immediate telephone contact with healthcare team and follow-up are in place.

8. The child/youth and their principal carer demonstrate the ability to follow safety instructions.

**Table 5.** BCCH selection criteria for subcutaneous lidocaine therapy in child/youth.

• Time between infusions: usually a month

• Loading dose: 1 mg/kg bolus

82 Pain Relief - From Analgesics to Alternative Therapies

• Location and monitors as above

• Loading dose: 1 mg/kg bolus

Of 336 new children/youth seen as out-patients by one pain physician in our institution over a 6.5 year time frame, only 45 (13%) were considered appropriate for trial of IVLT; 36/45 (80%) of these patients were females. The diagnoses, IVLT treatments and outcomes for these 45 children/youth are shown in **Tables 6** and **7**.


**Table 6.** Diagnoses and number of IVLT treatments received as part of 3P treatment package.


**Table 7.** Improved outcomes reported by patients following 3P treatment including intravenous lidocaine therapy (IVLT).

It is clear that not all children and youth with chronic pain are candidates for IVLT. Focus should be on pain conditions with a neuropathic or central element. However, when appropriately selected, and integrated in multi-disciplinary care, IVLT can be part of the reason that children and youth experience less pain facilitating healthier sleep, improved physical activities, and return to school. It is also clear that not all children/youth considered appropriate for IVLT respond positively. This needs to be clearly outlined with a plan of management prior to embarking on an IVLT therapy.
