Does Viscous Lidocaine Improve Fluid Intake in Children with Mouth Sores?

Katherine Bakes, MD

Cherry-flavored viscous lidocaine offered no benefit over placebo gel in an Australian study.

In a randomized placebo-controlled trial, investigators evaluated the effect of 2% viscous lidocaine on oral fluid intake in children aged 6 months to 8 years presenting to a Melbourne pediatric emergency department with painful infectious mouth conditions inhibiting oral intake. Patients were included if they were not toxic and had gingivostomatitis, ulcerative pharyngitis, herpangina, or hand-foot-mouth disease and a history of poor oral fluid intake in the 2 hours before presentation.

During a 3-year period, a convenience sample of 100 children (median age, 2 years) was randomized to receive either cherry-flavored 2% viscous lidocaine or cherry-flavored placebo gel. Treating nurses used a syringe to administer 0.15 mL/kg of the study mixture, aiming to coat inflamed mucosa and ulcers; children swallowed or spat out the mixture. Afterwards, staff actively encouraged children to take oral fluids.

At 60 minutes after administration, oral intake was similar between the lidocaine and placebo groups (median intake, 8.5 mL/kg and 9.3 mL/kg). There also were no differences between groups in emergency department length of stay, proportion of children requiring additional treatments (analgesia, intravenous or nasogastric fluids), or need for hospital admission.

Citation(s):

Hopper SM et al. Topical lidocaine to improve oral intake in children with painful infectious mouth ulcers: A blinded, randomized, placebo-controlled trial. Ann Emerg Med 2013 Nov 7; [e-pub ahead of print].