The Effect of Pretreatment With Intravenous Lidocaine for Intravenous Contrast:
Status:
Not yet recruiting
Trial end date:
2023-12-31
Target enrollment:
Participant gender:
Summary
Intravenous contrast media is commonly used for CT scans for improved image clarity in
pediatric emergency medicine. Children who feel discomfort during the administration of IV
contrast media may not remain still during the CT scan, which affects the overall study
quality and reliability. Therefore, many young patients often undergo procedural sedation in
anticipation of movement artifact degrading the diagnostic accuracy. Procedural sedation,
while a common procedure in the pediatric emergency department, does have significant
complications, and it increases the risk of adverse events for the patient. The risk of
airway compromise associated with procedural sedation is particularly concerning in children
requiring IV contrast for imaging of an upper airway pathology such as retropharyngeal
abscess, as the disease itself narrows the airway. This presents the physician with a dilemma
of assessing the extent of the disease without the additional risk of airway compromise by
using procedural sedation.Previous research has looked at premedication with steroids prior
to IV-contrast media administration to avert an allergic response. However, there has been no
investigation of premedication to abate the immediate adverse effects of discomfort
associated with IV contrast injection. The safety of IV lidocaine in pediatric patients has
been documented in studies of its use for post-operative pain, using doses from 1.0 to 1.5
mg/kg with no known adverse side effects. CT scans with IV contrast are performed on a
near-daily basis in the Maimonides pediatric emergency department, usually for the assessment
of acute appendicitis. The standard of care in children and adults receiving IV contrast does
not include pre-medication to prevent IV contrast-associated discomfort. This double-blinded
prospective study aims to determine whether pre-treatment with lidocaine can mitigate the
immediate discomfort of IV contrast in verbal children and adolescents who can comply with a
pre and post IV contrast pain assessment.