title: Opiate refractory pain from an intestinal obstruction responsive to an intravenous lidocaine infusion.
abstract: A 24-year-old female patient presented to our community emergency department (ED) for abdominal pain that had progressively worsened over the last 28 hours. Of note, 1 month prior to her presentation, the patient had a colostomy due to a rectal abscess and required stoma revision 5 days prior to her visit to our ED. The patient's pain was refractory to opiate analgesia in our ED, but experienced significant relief after an intravenous lidocaine infusion. Computer tomography of the abdomen and pelvis ultimately revealed a large bowel obstruction just proximal to the colostomy site. Historically, options for ED management of severe pain have been limited beyond narcotic analgesia. For patients whom are refractory to opiates in the ED, or for whom opiates are contraindicated, lidocaine infusions have shown promise for a variety of both acute and chronic painful conditions.
authors: Emergency Medicine, Columbia Memorial Hospital, 71 Prospect Avenue, Hudson, NY 12534. Electronic address: pbafuma@gmail.com.
authors: Patrick J
authors: PJ
authors: Bafuma
authors: Emergency Medicine, Columbia Memorial Hospital, 71 Prospect Avenue, Hudson, NY 12534. Electronic address: nandia@ema.net.
authors: Arun
authors: A
authors: Nandi
authors: Emergency Medicine, Columbia Memorial Hospital, 71 Prospect Avenue, Hudson, NY 12534. Electronic address: weisbergm@ema.net.
authors: Michael
authors: M
authors: Weisberg
mesh_terms: D015746:Abdominal Pain / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D000932:Antiemetics / Q000627:therapeutic use; D003125:Colostomy; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D004091:Hydromorphone / Q000627:therapeutic use; D007262:Infusions, Intravenous; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging*; D008012:Lidocaine / Q000008:administration & dosage / Q000627:therapeutic use*; D008787:Metoclopramide / Q000627:therapeutic use; D010098:Oxycodone / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000932:Antiemetics; D008012:Lidocaine; D010098:Oxycodone; D008787:Metoclopramide; D004091:Hydromorphone