Comparison of intravenous lidocaine versus morphine in alleviating pain in patients with critical limb ischaemia

Vahidi, Elnaz; Shakoor, Delaram; Meybodi, Mohamad Aghaie; Saeedi, Morteza

doi:10.1136/emermed-2014-203944

Cited by 35 publications

(24 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A prospective double-blind trial randomized ED patients with critical limb ischemia to receive either a single dose of IV lidocaine (20 patients; mean dose 2 mg/kg) or IV morphine (20 patients; mean dose 0.1 mg/kg) administered over 5 minutes. 22 After 30 minutes, the mean decrease in VAS scores was significantly more in 1254 PHARMACOTHERAPY Volume 38, Number 12, 2018 This study showed that IV lidocaine appears safe and effective in alleviating acute pain within 30 minutes due to critical limb ischemia. However, the short follow-up period of 30 minutes and the small sample size may not have been sufficient to detect adverse events.…”

Section: Critical Limb Ischemiamentioning

confidence: 71%

“…A prospective double‐blind trial randomized ED patients with critical limb ischemia to receive either a single dose of IV lidocaine (20 patients; mean dose 2 mg/kg) or IV morphine (20 patients; mean dose 0.1 mg/kg) administered over 5 minutes . After 30 minutes, the mean decrease in VAS scores was significantly more in the lidocaine group compared with the morphine group (−3.25 vs −1.15, 95% CI 1.22–3.28), respectively.…”

Section: Resultsmentioning

confidence: 99%

“…Although the quality of evidence was very low, lidocaine was efficacious as an analgesic for a variety of acute pain indications. When lidocaine was studied against an active comparator, it showed a greater reduction in VAS and higher response rate as compared with morphine for both critical limb ischemia and renal colic . In addition, lidocaine showed no difference in efficacy compared with ketorolac for the treatment of acute radicular low back pain, possibly a result of lidocaine's antiinflammatory properties .…”

Section: Discussionmentioning

confidence: 99%

“…In all studies, liver function tests were routinely monitored at least once/day. Patients in the cited studies had baseline characteristics notable for a cardiac history (26%), an arrhythmia history (10%), and a history of hypertension (25%) . There were no reports of any new arrhythmias associated with lidocaine use; however, one patient in hospice care died suddenly .…”

Section: Discussionmentioning

confidence: 99%

“…Although the optimal dosing regimen for analgesia has yet to be determined, IV lidocaine administration was shown to be safe for up to 48 hours. Dosing ranges for IV lidocaine used for analgesia varied and included a 1-to 2-mg/kg bolus dose, 19,21,22,30 a fixed 50-to 100-mg bolus dose, 20,23,29,37 and a 1-mg/kg/hour continuous infusion. 24,31,33 Because lidocaine dosing is weight based for all indications approved by the U.S. Food and Drug Administration, a reasonable dose of lidocaine for acute pain is a bolus between 1 and 2 mg/kg.…”

Section: Discussionmentioning

confidence: 99%

See 4 more Smart Citations

Intravenous Lidocaine for Acute Pain: A Systematic Review

et al. 2018

View full text Add to dashboard Cite

This systematic review evaluates the safety and efficacy of intravenous (IV) lidocaine for the treatment of acute pain in adult patients. The PubMed database was searched for randomized controlled trials, retrospective cohort studies, case series, and case reports evaluating the use of IV lidocaine for the treatment of acute pain in adult patients, published between January 1970 and January 2018. The primary outcome was pain reduction via the Visual Analog Scale, Verbal Rating Scale, or Numeric Rating Scale among patients treated with IV lidocaine and placebo or active controls. Safety outcomes included both nonserious and serious adverse events. A total of 347 titles and abstracts were screened, and after full‐text review, 13 studies met the inclusion criteria involving 512 patients. The four active controls studied were IV morphine, IV ketorolac, IV dihydroergotamine (DHE), and IV chlorpromazine (CPZ). The dosing of IV lidocaine varied among studies between a weight‐based dose of a 1‐ to 2‐mg/kg bolus, a fixed‐bolus dose of 50–100 mg, and a 1‐mg/kg/hour continuous infusion. Monitoring of serum lidocaine concentrations was not done routinely. Intravenous lidocaine had superior efficacy to morphine for renal colic and critical limb ischemia, superior efficacy to DHE for acute migraine, and equivalent efficacy to ketorolac for acute radicular lower back pain. However, lidocaine was less effective than CPZ for the treatment of acute migraine. The most common adverse event reported among all studies were neurologic effects such as altered mental status and slurred speech. Due to the inconsistency in dosing, length of administration, and lack of serum monitoring, the absolute safety of IV lidocaine for acute pain is unknown. Larger, prospective studies are needed before the routine use of IV lidocaine can be recommended for all types of acute pain.

show abstract

Section: Critical Limb Ischemiamentioning

confidence: 71%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%