title: The in vitro mechanisms and in vivo efficacy of intravenous lidocaine on the neuroinflammatory response in acute and chronic pain.
abstract: BACKGROUND
  The neuroinflammatory response plays a key role in several pain syndromes. Intravenous (iv) lidocaine is beneficial in acute and chronic pain. This review delineates the current literature concerning in vitro mechanisms and in vivo efficacy of iv lidocaine on the neuroinflammatory response in acute and chronic pain.
  
  
  METHODS
  We searched PUBMED and the Cochrane Library for in vitro and in vivo studies from July 1975 to August 2014. In vitro articles providing an explanation for the mechanisms of action of lidocaine on the neuroinflammatory response in pain were included. Animal or clinical studies were included concerning iv lidocaine for acute or chronic pain or during inflammation.
  
  
  RESULTS
  Eighty-eight articles regarding iv lidocaine were included: 36 in vitro studies evaluating the effect on ion channels and receptors; 31 animal studies concerning acute and chronic pain and inflammatory models; 21 clinical studies concerning acute and chronic pain. Low-dose lidocaine inhibits in vitro voltage-gated sodium channels, the glycinergic system, some potassium channels and Gαq-coupled protein receptors. Higher lidocaine concentrations block potassium and calcium channels, and NMDA receptors. Animal studies demonstrate lidocaine to have analgesic effects in acute and neuropathic pain syndromes and anti-inflammatory effects early in the inflammatory response. Clinical studies demonstrate lidocaine to have advantage in abdominal surgery and in some neuropathic pain syndromes.
  
  
  CONCLUSIONS
  Intravenous lidocaine has analgesic, anti-inflammatory and antihyperalgesic properties mediated by an inhibitory effect on ion channels and receptors. It attenuates the neuroinflammatory response in perioperative pain and chronic neuropathic pain.
authors.affiliation: Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center (RUMC), Nijmegen, The Netherlands.
authors.forename: S E I
authors.initials: SE
authors.lastname: van der Wal
authors.affiliation: Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center (RUMC), Nijmegen, The Netherlands.
authors.forename: S A S
authors.initials: SA
authors.lastname: van den Heuvel
authors.affiliation: Department of Medical Oncology, RUMC, Nijmegen, The Netherlands.
authors.forename: S A
authors.initials: SA
authors.lastname: Radema
authors.affiliation: Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center (RUMC), Nijmegen, The Netherlands.
authors.forename: B F M
authors.initials: BF
authors.lastname: van Berkum
authors.affiliation: Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center (RUMC), Nijmegen, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Vaneker
authors.affiliation: Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center (RUMC), Nijmegen, The Netherlands.
authors.forename: M A H
authors.initials: MA
authors.lastname: Steegers
authors.affiliation: Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center (RUMC), Nijmegen, The Netherlands.
authors.forename: G J
authors.initials: GJ
authors.lastname: Scheffer
authors.affiliation: Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center (RUMC), Nijmegen, The Netherlands.
authors.forename: K C P
authors.initials: KC
authors.lastname: Vissers
mesh_terms: D059787:Acute Pain / Q000188:drug therapy*; D061605:Administration, Intravenous; D000779:Anesthetics, Local / Q000494:pharmacology / Q000627:therapeutic use*; D000818:Animals; D015220:Calcium Channels / Q000187:drug effects; D059350:Chronic Pain / Q000188:drug therapy*; D006801:Humans; D066298:In Vitro Techniques; D008012:Lidocaine / Q000494:pharmacology / Q000627:therapeutic use*; D009437:Neuralgia / Q000188:drug therapy; D015221:Potassium Channels / Q000187:drug effects; D016194:Receptors, N-Methyl-D-Aspartate / Q000187:drug effects
chemical_list: D000779:Anesthetics, Local; D015220:Calcium Channels; D015221:Potassium Channels; D016194:Receptors, N-Methyl-D-Aspartate; D008012:Lidocaine