Continuous Lidocaine Infusion as Adjunctive Analgesia in Intensive Care Unit Patients

Abstract

Despite a paucity of data, the role of intravenous lidocaine (IVLI) as adjunctive analgesia in the intensive care unit (ICU) seems promising due to a low potential to contribute to respiratory depression. A retrospective chart review was conducted to evaluate the safety and effectiveness of IVLI for the treatment of pain in ICU patient with varying degrees of organ dysfunction from March 2014 to March 2016. The primary outcomes included the time to a ≥ 20 % reduction in pain scores after the initiation of IVLI and the difference in opioid requirements as well as pain scores prior to and during IVLI therapy. Other variables included the presence of IVLI-related adverse events and the dosage and duration of IVLI. A total of 21 ICU patients were included from two different hospitals. The mean time to a ≥ 20 % reduction in pain scores from the start of IVLI was 3.3 hours (SD = 2.2). The median morphine dose equivalents required during 6, 12, and 24 hours pre-IVLI were significantly higher compared to the same time periods after IVLI (18.3 vs. 10 mg, p=0.002; 41.8 vs. 18.3 mg, p=0.002; 93.5 vs. 30.5 mg, p=0.037). Neurological adverse effects of lidocaine were noted in 3 patients, but the effects were reversed upon IVLI discontinuation. This report suggested that IVLI as an adjunctive agent in the treatment of acute pain may be a potential option in ICU patients who are refractory to opioids or those in whom opioid-induced respiratory depression is a concern.

Intravenous Lidocaine for Acute Pain: A Systematic Review

“…A total of 21 adults received an average lidocaine dose of 0.93 mg/kg as a continuous infusion for a mean duration of 48 hours. The mean time to a more than a 20% reduction in patient self‐reported pain scores or adult nonverbal pain scores from the start of IV lidocaine was 3.3 hours that may have been due to the lack of a loading dose . Furthermore, the median morphine dose equivalents required during 6, 12, and 24 hours pre‐IV lidocaine were significantly higher compared with the same time periods after IV lidocaine (18.3 mg vs 10 mg at 6 hrs, p=0.002; 41.8 mg vs 18.3 mg at 12 hrs, p=0.002; 93.5 mg vs 30.5 mg at 24 hrs, p=0.037), respectively.…”

“…A multicenter retrospective study evaluated the safety and effectiveness of IV lidocaine as an adjunctive analgesic for the treatment of unspecified acute pain in intensive care unit (ICU) patients. 24 Most patients were admitted to the ICU due to respiratory failure after abdominal surgery. A total of 21 adults received an average lidocaine dose of 0.93 mg/kg as a continuous infusion for a mean duration of 48 hours.…”

Continuous Intravenous Lidocaine Infusion: Effective Analgesic Choice in a Complex Critically Ill Patient

“…However, there is a lack of evidence regarding safety and effectiveness of intravenous lidocaine in critically ill patients [1]. A recently published Cochrane review [5] includes 45 trials involving 2802 participants.…”

“…Consequently, the need to manage acute pain in this population is becoming more frequent in postoperative intensive care units (ICU). Systemic lidocaine infusion may be a useful analgesic adjunct in the critically ill patient who might be in severe pain not relieved by high-dose opioid therapy [1]. Lidocaine infusion attenuates several complications caused by opioids such as respiratory depression, sedation, and ileus by reducing opioid requirements, which takes on importance particularly in the elderly population.…”

“…Currently, the evidence evaluating the use of intravenous lidocaine infusion in ICU patients is very limited. A recent published retrospective study found that intravenous lidocaine appeared to reduce opioid requirements in ICU patients with low-dose regimens (2 mg/ min) [1].…”