Lidocaine Infusions and Other Options for Opioid‐Resistant Pain Due to Pediatric Advanced Cancer

Berde, Charles B.; Koka, Anjali; Donado-Rincon, Carolina

doi:10.1002/pbc.26009

Cited by 10 publications

(13 citation statements)

References 14 publications

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“…1,4 Only one out of the three practice guidelines mentioned the need for close monitoring during drug administration outside the hospital context. 14 Serum Lidocaine levels were only assayed in two studies where there were empirical trials of treatment and even then, not consistently. 4,15 It was nonetheless recommended in two practice guideline articles for the purpose of titrating to efficacy and preventing toxicity.…”

Section: Resultsmentioning

confidence: 99%

“…4,15 It was nonetheless recommended in two practice guideline articles for the purpose of titrating to efficacy and preventing toxicity. 14,19 All articles reported positive outcomes for analgesia in the management of complex cancer pain. None, however, had used validated outcome measures for pain.…”

Section: Resultsmentioning

confidence: 99%

“…Otherwise, the patients could have declined or were too vulnerable for any invasive intervention. 4,14 Lidocaine appears promising as one of several multimodal approaches in the management of complex cancer pain. 13,15,16 Lidocaine is an amide local anesthetic and class 1B antiarrhythmic agent.…”

Section: Introductionmentioning

confidence: 99%

“…13,15,16 Lidocaine is an amide local anesthetic and class 1B antiarrhythmic agent. 17,18 Systemic Lidocaine, 14,19 administered either intravenously (IV) or subcutaneously (SC) as opposed to local injections, epidural, or intrathecal routes, is the focus of this review. Its pharmacological effects are achieved through nonselective blockage of voltage and frequency dependent sodium channels on nerve membranes.…”

Section: Introductionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

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

Chong¹,

Yeo²

2021

Journal of Palliative Medicine

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Background: Cancer pain can remain refractory despite escalating opioids and adjuvants. Systemic Lidocaine is an option, but current approaches are hospital centered. While advantageous in advanced cancer, evidence is lacking for parenteral Lidocaine use in community-based care. Objectives: Review evidence for parenteral lidocaine in complex cancer pain outside the hospital setting. Design: Systematic review of peer-reviewed articles of any study design, including reviews. Search in four databases used keyword variations of “cancer,” “pain,” “Lidocaine,” and “parenteral.” Search was extended through reference lists of full texts assessed. Abstracted data from articles screened and selected were synthesized narratively by a palliative care clinician in Singapore. Results: Eight hundred eighty-three articles identified were screened by title and abstract. Twenty-eight full texts were assessed. Seven articles fulfilled criteria for synthesis of findings. A total of 73 patients received parenteral Lidocaine for mixed pains, reported collectively in 1 retrospective chart review, 3 practice guidelines, 2 case series, and 1 case study. Intravenous or subcutaneous Lidocaine was commenced in hospital or hospice and continued at home. Dosages and administration schedules varied, involving slow bolus with continuous infusion or the latter alone, for up to 240 days. All produced positive outcomes, with no severe adverse events. Monitoring included routine vital signs and conscious levels; electrocardiogram, liver, and renal function tests were uncommon. Lidocaine levels were not consistently assessed. Conclusion: Parenteral Lidocaine can be effective and safe in the community setting. More empirical studies are needed to inform patient selection and treatment protocol, and to validate expected outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Chong¹,

Yeo²

2021

Journal of Palliative Medicine

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Pain Management in Children

Greco

Berde

2020

Gregory's Pediatric Anesthesia

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Lidocaine infusions and reduced opioid consumption—Retrospective experience in pediatric hematology and oncology patients with refractory pain

Anghelescu

Morgan

Frett

et al. 2021

Pediatric Blood & Cancer

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Background Despite a more robust experience with lidocaine infusions for pain management in adults and general pediatric population, there is limited evidence of efficacy of lidocaine infusions for pain management in patients with pediatric hematology and oncology diagnoses. Methods Data pertaining to continuous intravenous lidocaine infusions prescribed between January 2009 and June 2019 were reviewed, including patients’ demographic characteristics, hematology/oncology and pain diagnoses, concurrent pain medications, and lidocaine infusion dose regimens and duration. Pain scores and opioid consumption calculations based on morphine equivalent doses (mg/kg/day) of patient‐controlled analgesia were collected 1 day before infusion (D1), during infusion (D2), and 1 day after infusion (D3). Results The mean opioid consumption on D3 was significantly lower than that on D2 (p = .01). The pain scores on D3 were significantly lower than those on D1 when measured as average pain scores per 24 hours (p < .001) or as single pain scores immediately before and after infusions (p < .001). No significant associations were found between cumulative doses of lidocaine (loading dose plus total infusion dose) and either a decrease in the opioid consumption or a decrease in pain scores. Conclusions In this retrospective series of pediatric hematology and oncology cases, we report positive outcomes in reducing opioid consumption and pain scores after lidocaine infusions. Prospective investigations designed in a collaborative, multi‐institutional fashion, including a variety of pediatric populations are needed to further investigate the efficacy of lidocaine infusions.

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Lidocaine Infusions and Other Options for Opioid‐Resistant Pain Due to Pediatric Advanced Cancer

Cited by 10 publications

References 14 publications

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

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

Pain Management in Children

Lidocaine infusions and reduced opioid consumption—Retrospective experience in pediatric hematology and oncology patients with refractory pain

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