982: Intravenous Lidocaine Infusion for Management of Pain in the Intensive Care Unit

Jung, Sharon; Ottestad, Einar; Aggarwal, Anuj; Flood, Pamela; Nikitenko, Vitaliy

doi:10.1097/01.ccm.0000633464.81931.28

Cited by 3 publications

(4 citation statements)

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“…[11][12][13][14] Lidocaine infusion has also been successfully used in ICU settings to reduce pain, decrease opioid utilization, and lower non-verbal pain scores. 15 With current emphasis on reduction of opioids throughout the practice of medicine, lidocaine infusion is an attractive, minimally invasive adjunct in multimodal pain control, but is scantly researched in the rib fracture population. A pilot study at our institution comparing pain scores and morphine dose equivalency in 100 patients undergoing lidocaine infusion for rib analgesia did not demonstrate significant differences at 24 and 48 h of infusion.…”

Section: Discussionmentioning

confidence: 99%

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Intravenous Lidocaine for Rib Fractures: Effect on Pain Control and Outcome

King

Smith

Harper

et al. 2021

The American Surgeon

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Background Multimodal analgesia in rib fractures (RFs) is designed to maximize pain control while minimizing narcotics. Prior research with intravenous lidocaine (IVL) efficacy produced conflicting results. We hypothesized IVL infusion reduces opioid utilization and pain scores. Methods A retrospective review of RF patients at an ACS-verified Level I trauma center from April 2018 to 2/2020 was conducted. Patients (pts) stratified as receiving IVL vs no IVL. Initial lidocaine dose: 1 mg/kg/hr with a maximum of 3 mg/kg/hr. Duration of infusion: 48 h. Pain quantified by the Stanford Pain Score system (PS). Bivariate and multivariate analyses of variables were performed on SPSS, version 21 (IBM Corp). Results 414 pts met inclusion criteria: 254 males and 160 females. The average age for the non-IVL = 67.4 ± 15.2 years vs IVL = 58.3 ± 17.1 years ( P < .001). There were no statistically significant differences between groups for ISS, PS for initial 48 h, and ICU length of stay (LOS). There was a difference in morphine equivalents per hour: non-IVL = 1.25 vs IVL = 1.72 ( P = .004) and LOS non-IVL = 10.2+/−7.6 vs IVL = 7.82+/−4.94. By analyzing IVL pts in a crossover comparison before and after IVL, there was reduction in opiates: 3.01 vs 1.72 ( P < .001) and PS: 7.0 vs 4.9 ( P < .001). Stanford Pain Score system reduction in the IVL = 48.3 ± 23.9%, but less effective in narcotic dependency (27 ± 22.9%, P = .035); IVL pts had hospital cost reduction: $82,927 vs $118,202 ( P < .01). Discussion In a crossover analysis, IVL is effective for reduction of PS and opiate use and reduces hospital LOS and costs. Patient age may confound interpretation of results. Our data support IVL use in multimodal pain regimens. Future prospective study is warranted.

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Section: Discussionmentioning

confidence: 99%

“…11-14 Lidocaine infusion has also been successfully used in ICU settings to reduce pain, decrease opioid utilization, and lower non-verbal pain scores. 15…”

Section: Discussionmentioning

confidence: 99%

Intravenous Lidocaine for Rib Fractures: Effect on Pain Control and Outcome

King

Smith

Harper

et al. 2021

The American Surgeon

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“…[136][137][138] Studies examining the use of lidocaine infusions in the general ICU are limited to retrospective, case-controlled studies. 136,139 In these studies, the addition of lidocaine infusion resulted in a reduction in opioid consumption and pain scores. However, acute neurological adverse effects (decreased conscious state, confusion) were noted in patients who developed acute kidney injury with resultant elevated serum lidocaine levels.…”

Section: Non-opioid Adjuvant Analgesicsmentioning

confidence: 99%

The complications of opioid use during and post–intensive care admission: A narrative review

Moran

Myburgh

Scott

2022

Anaesth Intensive Care

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Opioids are a commonly administered analgesic medication in the intensive care unit, primarily to facilitate invasive mechanical ventilation. Consensus guidelines advocate for an opioid-first strategy for the management of acute pain in ventilated patients. As a result, these patients are potentially exposed to high opioid doses for prolonged periods, increasing the risk of adverse effects. Adverse effects relevant to these critically ill patients include delirium, intensive care unit–acquired infections, acute opioid tolerance, iatrogenic withdrawal syndrome, opioid-induced hyperalgesia, persistent opioid use, and chronic post–intensive care unit pain. Consequently, there is a challenge of optimising analgesia while minimising these adverse effects. This narrative review will discuss the characteristics of opioid use in the intensive care unit, outline the potential short-term and long-term adverse effects of opioid therapy in critically ill patients, and outline a multifaceted strategy for opioid minimisation.

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“…[4][5][6][7][8][9] Intravenous lidocaine infusion (IVL i ) has been shown to improve pain scores, hospital length of stay (LOS), and reduce opioid use in the intensive care setting and after laparoscopic/open abdominal surgery and hernia repair. [10][11][12][13] It has been utilized in studies evaluating its effectiveness in patients with rib fractures. [6][7][8][9] Effects of IVL i on LOS, pain scores, and amount of opiates consumed within these studies have produced incongruent results.…”

Section: Introductionmentioning

confidence: 99%

Improving Opioid Prescribing Post-Discharge for Trauma Patients With Rib Fractures: Factors in Prevention of Prolonged Use and Dependency

King

Harper

Smith

et al. 2022

The American Surgeon

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Background Rib fracture (RF) pain management provides analgesia while reducing opioids. We postulated: (1) Prescriber factors affect opiate duration, and (2) lidocaine infusion curtails dependency. Materials and Methods Retrospective study of RF patients undergoing multimodal analgesia at ACS-verified Level 1 Trauma Center April 2018-February 2020. Exclusions: age<18 y/o, GCS < 14, hospital length of stay (LOS) <3 d, <3 RF, ventilator support, injury-related mortality, disclosed/discoverable, acute/chronic opiate Rx within 90 days preadmission, substance abuse, patient inaccessible via Controlled Substance Monitoring Database (CSMD), and/or not using opioids in-/post-hospitalization. CSMD queried regarding opioid prescriptions filled by cohort. Cohort variable analysis performed on SPSS Version 27sf (Armonk, NY: IBM Corp). Results 153 patients included – 113 (74%) stopped opiates by 30 days post-discharge (NORx30), 40 (26%) continued beyond 30 days (Rx+). No significant differences in age, gender, ISS, number of RF, bilaterality, flail chest, and discharge disposition. Significant differences included hospital LOS (7.62 NORx30 vs. 10.22 Rx+, p = .02), number of prescribers (1.73 NORx30 vs. 2.98 Rx+, p < .01), average MME/day during initial 30 days post-discharge (36.7 ± 17 NORx30 vs. 45.4 ± 30.2 Rx+, p = .03), and number of pills (49 ± 38 NORx30 vs. 120 ± 85 Rx+, p < .01). Patients who received lidocaine infusion (LIDO+) had lower MME/day prescribed (32.24 ± 19.9, p = .03), were younger (61.2 vs. 65.6, p < .01), had more RFs (7.1 vs. 6.05, p = .03), and shorter LOS (7.71 vs 10.2, p = .01). Discussion Prescriber attention to MME/day and number of pills dispensed affects opioid dependency. We recommend 35–40 MME/day with 50 pill/month limit prescribed by a single provider monitoring patient and CSMD. Early LI offers post-discharge opioid cessation advantage.

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982: Intravenous Lidocaine Infusion for Management of Pain in the Intensive Care Unit

Cited by 3 publications

References 0 publications

Intravenous Lidocaine for Rib Fractures: Effect on Pain Control and Outcome

Intravenous Lidocaine for Rib Fractures: Effect on Pain Control and Outcome

The complications of opioid use during and post–intensive care admission: A narrative review

Improving Opioid Prescribing Post-Discharge for Trauma Patients With Rib Fractures: Factors in Prevention of Prolonged Use and Dependency

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