Intravenous Lidocaine Administered as Twice Daily Bolus and Continuous Infusion for Intractable Cancer Pain and Wound Care Pain

Parenteral Lidocaine for Complex Cancer Pain in the Home or Inpatient Hospice Setting: A Review and Synthesis of the Evidence

“…The degree of workup before commencement of treatment and extent of hemodynamic monitoring during drug administration are different from those where parenteral Lidocaine was given in the hospital setting. 5 , 11 , 17 , 20 , 22 Assessment of liver and renal function before Lidocaine administration was only explicitly recommended in one article. 19 Similarly, an ECG was performed only in one pediatric patient before Lidocaine infusion was commenced.…”

“…With a half-life of 90 to 120 minutes, it is rapidly distributed systemically before hepatic metabolism and renal excretion. 22 While half-life can increase with infusion beyond 24 hours, drug levels decrease equally rapidly after administration is stopped (less than an hour after continuous infusion for 3 days). 13 , 20 Efficacy is noted precipitously once the drug level reaches a “break point,” with adverse effects noticed soon after, as another threshold is crossed—characteristic of its steep dose-response curve and narrow therapeutic index mentioned before.…”

“…2 Pain and palliative physicians have administered Lidocaine in multiple ways-including slow bolus (single or repeated), continuous infusion (over varying periods), or a combination of both (the initial bolus often a ''challenge'' dose that determines if an infusion follows). 12,21,22 Acknowledging a steep dose-response curve, 17,23 a minimum threshold drug level before benefits are observed, 1,15 and a narrow therapeutic index with risks of neuromuscular and cardiac toxicity, 13,14 almost all initiations of parenteral Lidocaine are performed in the institutional setting under close monitoring. This may include a baseline electrocardiogram (ECG), laboratory tests (cardiorespiratory screening, liver, and renal panels), and continuous nursing observation throughout drug administration.…”

An Analysis of Lidocaine Usage in the Treatment of Squamous Cell Carcinoma

“…Small subanesthetic doses of ketamine have been administered topically or intravenously as an analgesic for the treatment of chronic pain. While ketamine has shown beneficial effects when it comes to analgesia and pain, there are certain side effects associated with its use [13][14][15][16][17]. Patients who received ketamine during surgery were more likely to experience hallucinations and nightmares in the recovery room and for several days following surgery.…”

“…than other types of anesthesia (e.g., intravenous or intradermal) due to its localized mechanism of action. Topical administration of lidocaine also results in a shorter duration of nerve blocking, which provides a shorter recovery time for patients [14][15][16][17][18][19][20][21][22]30]. As a result, topical lidocaine would be favored for shorter procedures to reduce the likelihood of severe postoperative symptoms and complications.…”