Intravenous lidocaine relieves severe pain: results of an inpatient hospice chart review.
BACKGROUND
Parenteral lidocaine has been reported to relieve neuropathic pain and/or pain refractory to opioid therapy.


METHODS
A retrospective chart review of 768 consecutive patients acutely admitted to a hospice inpatient unit was performed to assess the efficacy and tolerability of parenteral lidocaine for pain relief.


RESULTS
Eighty-two patients (approximately 11%) received parenteral lidocaine. Typically, a patient received a parenteral bolus and pain relief was evaluated 30 minutes later. If there was an effect, a continuous infusion was started. Sixty-one patients receiving lidocaine were evaluable for pain relief response. Fifty patients (82% of evaluable patients) reported a major response of their pain to lidocaine. Five patients (8% of evaluable patients) reported a partial response. Six (10% of evaluable patients) reported no benefit.


CONCLUSIONS
Evaluable patients in an opioid refractory class had a 91% major response rate to lidocaine. Overall, lidocaine was well tolerated. Approximately 30% of evaluable patients reported some adverse event; the most common being lethargy. However, the effect was not clearly related to lidocaine.


CONCLUSIONS
Parenteral lidocaine appears to be rapidly effective for opioid refractory pain and is well tolerated. A randomized controlled trial is needed to confirm these impressive but preliminary uncontrolled results.
Thomas
Jay
J
San Diego Hospice and Palliative Care, San Diego, California 92103, USA. jthomas@sdhospice.org
Kronenberg
Robert
R
Cox
Michael Craig
MC
Naco
Gilbert C
GC
Wallace
Mark
M
von Gunten
Charles F
CF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D002140:California; D004363:Drug Utilization; D005260:Female; D017051:Hospice Care; D006757:Hospital Units; D006801:Humans; D007275:Injections, Intravenous; D008012:Lidocaine / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D012189:Retrospective Studies; D016896:Treatment Outcome
D000779:Anesthetics, Local; D008012:Lidocaine