Parenteral lidocaine for severe intractable pain in six hospice patients continued at home.
A small number of patients at the end of life suffer from severe or intractable pain that is difficult to manage with opioids. We have observed that lidocaine infusions successfully treat otherwise severe refractory pain syndromes. In general, the lidocaine infusion is continued for a few days and gradually supplanted by oral adjuvant analgesics or by invasive pain management techniques. We report six cases where prolonged lidocaine infusions were successfully continued in the home care setting. The average lidocaine infusion rate was 44 mg/hour (range 10-80 mg/h), serum levels ranged from 1.5-9.3 microg/mL, and duration of therapy ranged from 24-240 days. Mechanisms of action of lidocaine and sodium channel blocking adjuvant analgesics are reviewed. Parenteral lidocaine deserves additional study for its ability to relieve pain in terminally ill patients.
Ferrini
R
R
Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, California 92093, USA. rferrini@san.rr.com