Intravenous Lidocaine for the Emergency Department Treatment of Acute Radicular Low Back Pain, a Randomized Controlled Trial

Tanen, David A.; Shimada, Masatoshi; Danish, David C.; Santos, Frank Dos; Makela, Martin; Riffenburgh, Robert H.

doi:10.1016/j.jemermed.2012.12.014

Cited by 21 publications

(19 citation statements)

References 15 publications

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“…A prospective double‐blind study randomized 41 patients who presented to the ED with acute radicular back pain to receive either IV lidocaine at a fixed‐dose of 100 mg (21 patients) or IV ketorolac 30 mg (20 patients) over 2 minutes as a single dose . The mean weight of patients in each group was 195 kg.…”

Section: Resultsmentioning

confidence: 99%

“…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 . The study that compared lidocaine with an NSAID was conducted in 2014, whereas opioid prescribing rates peaked in 2012.…”

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%

“…A prospective double-blind study randomized 41 patients who presented to the ED with acute radicular back pain to receive either IV lidocaine at a fixed-dose of 100 mg (21 patients) or IV ketorolac 30 mg (20 patients) over 2 minutes as a single dose. 23 The mean weight of patients in each group was 195 kg. Median VAS scores from baseline to 60 minutes were significantly reduced in both groups (8.3-0.8 in the lidocaine group [p=0.003] vs 7.9-1.4 in the ketorolac group [0.007]), yet no significant difference was observed in the degree of reduction between the two groups (p=0.84).…”

Section: Acute Radicular Lower Back Painmentioning

confidence: 99%

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Intravenous Lidocaine for Acute Pain: A Systematic Review

et al. 2018

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Acute Radicular Lower Back Painmentioning

confidence: 99%

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Intravenous Lidocaine for Acute Pain: A Systematic Review

et al. 2018

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“…Weak evidences exist about IV lidocaine use in status epilepticus and studies continue [4]. Using IV lidocaine in patients with low back pain did not have definite results but spinal cord injury pain responds to intravenous lidocaine [5,6]. Injured nerve, ganglion and neuromata produce ectopic discharges that are inhibited by lidocaine.…”

mentioning

confidence: 99%