Topical analgesic with lidocaine and tetracaine did not decrease need for propofol sedation during lumbar puncture in children with cancer. These findings, from a randomized, controlled, double-blind, crossover study, were published in the Journal of Hematology Oncology Pharmacy.
Children who require lumbar puncture for chemotherapy are often sedated to ensure procedural success. Exposure to common anesthetic agents, however, have been associated with altered brain development and the Food and Drug Administration (FDA) warns against repeated anesthesia for children. This study sought to evaluate whether a topical analgesic may decrease need for propofol sedation during lumbar puncture.
Between 2016 and 2018, 20 patients aged 3 to 21 years with acute leukemia or lymphoma who required 2 or more lumbar punctures at the West Virginia University Medicine Children’s Hospital were recruited for this study. Patients were randomly assigned in a 1:1 ratio to receive active drug patch with lidocaine and tetracaine (n=10) or placebo (n=10) at their first lumbar puncture and they received the opposite treatment at their second lumbar puncture. Propofol use and procedure length were evaluated.
Most patients were aged 3 to 5 years (55%), were girls or women (55%), and had high-risk disease (55%).
During procedures, the active treatment patch associated with increased procedural time (mean, 15.3 vs 11.7 min; P <.02) and longer recovery (mean, 16.10 vs 9.8 min; P <.05).
The average dose of propofol was 4.6 mg/kg for procedures with active treatment compared with 4.8 mg/kg for placebo procedures.
No significant differences in heart rate or postprocedure pain scores were observed.
Study limitations included a small sample size and the number of puncture attempts was not evaluated.
This study found little evidence that a topical lidocaine plus tetracaine patch decreased the propofol sedation dose needed during lumbar puncture among children with cancer.
Garavaglia LR, Casey F, Cottrell L, Faraon-Pogaceanu C, Paul S, Wright ML. Lidocaine plus Tetracaine-Medicated Patch Used for Propofol Sedation During Lumbar Punctures in Pediatric Patients with Blood Cancer.J Hematol Oncol Pharm. 2022;12(1):12-18.