Perioperative Intravenous Lidocaine Infusion Adverse Reaction: A Case Report

Kramer, MaryJo E; Holtan, Elizabeth E; Ives, Amy; Wall, Russell T.

doi:10.1213/xaa.0000000000001002

Cited by 10 publications

(5 citation statements)

References 13 publications

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“…Although the patient recovered after a few days, this case highlights the importance of using IV lidocaine judiciously, especially when a patient is on several medications, a few of which are metabolized by the CYP3A4 enzyme (39). Lidocaine levels should be monitored carefully and should remain within the therapeutic range as levels beyond 10mcg/mL, as seen in this patient, are associated with ventricular arrhythmias (40). See Table 2.…”

Section: Headachementioning

confidence: 86%

Utilization of Intravenous Lidocaine Infusion for the Treatment of Refractory Chronic Pain

et al. 2021

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Context: Chronic pain accounts for one of the most common reasons patients seek medical care. The financial burden of chronic pain on health care is seen by direct financial cost and resource utilization. Many risk factors may contribute to chronic pain, but there is no definite risk. Managing chronic pain is a balance between maximally alleviating symptoms by utilizing a therapeutic regimen that is safe for long-term use. Currently, non-opioid analgesics, NSAIDs, and opioids are some of the medical treatment options, but these have numerous adverse effects and may not be the best option for long-term use. However, Lidocaine can achieve both central and peripheral analgesic effects with relatively few side effects, which may be an ideal compound for managing chronic pain. Evidence Acquisition: This is a Narrative Review. Results: Infusion of lidocaine (2-(diethylamino)-N-(2,6-dimethylphenyl)acetamide), an amino-amide compound, is emerging as a promising option to fill the therapeutic void for treatment of chronic pain. Numerous studies have outlined dosing protocols for lidocaine infusion for the management of perioperative pain, outlined below. While there are slight variations in these different protocols, they all center around a similar dosing regimen to administer a bolus to reach a rapid steady state, followed by infusion for up to 72 hours to maintain the therapeutic analgesic effects. Conclusions: Lidocaine may be a promising pharmacologic solution with a low side effect profile that provides central and peripheral analgesia. Even though the multifaceted mechanism is not entirely understood yet, lidocaine may be a promising novel remedy in treating chronic pain in various conditions.

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Section: Headachementioning

confidence: 86%

Utilization of Intravenous Lidocaine Infusion for the Treatment of Refractory Chronic Pain

et al. 2021

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“…Kramer et al reported that a patient with HIV who was receiving highly effective antiretroviral therapy experienced four unresponsive episodes with tachycardia, hypertension, and oxygen desaturation on the 2nd day after the operation. 37 In the proposed trial, we will strictly limit the participants to those with ASA grades I-II. At the same time, to identify and manage potential adverse events in a timely manner, all participants will be monitored closely when the study drug is administered.…”

Section: Discussionmentioning

confidence: 99%

<p>Effect of Intravenous Lidocaine on Postoperative Pain in Patients Undergoing Intraspinal Tumor Resection: Study Protocol for a Prospective Randomized Controlled Trial</p>

Yue

Zhou

et al. 2020

JPR

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Patients undergoing intraspinal tumor resection usually experience severe acute pain, delaying postoperative rehabilitation, and increasing incidence of chronic pain. Recently, an increasing number of studies have found that low-dose intravenous lidocaine infusion during and/or after surgery can reduce opioid usage and the incidence of related side effects, inhibit hyperalgesia and promote recovery. Thus far, no studies have evaluated the analgesic effect and safety of perioperative intravenous lidocaine infusion for intraspinal tumor resection, especially the long-term analgesic effects of patient-controlled analgesia (PCA) with lidocaine during the first postoperative 48 hours. This study tests the hypothesis that intra-and postoperative systemic lidocaine infusion for patients undergoing intraspinal tumor resection can relieve postoperative acute or chronic pain and reduce the opioid dosage and incidence of related side effects without other problems. Study Design and Methods: This is a prospective, randomized, placebo-controlled, and double-blinded study. In total, 180 participants scheduled for intraspinal tumor resection will be randomly divided into lidocaine and placebo groups. The lidocaine group will be administered lidocaine intravenously during anesthesia and postoperative pain management during the first 48 postoperative hours; the placebo group will be administered normal saline at the same volume, infusion rate, and timing. The primary outcome will be the postoperative visual analog scale (VAS) score. Secondary outcomes will be postoperative cumulative sufentanil consumption, indicators of postoperative recovery, and the incidence of perioperative adverse events. Discussion: This study investigates the effect of continuous intravenous lidocaine infusion on postoperative sufentanil consumption and VAS scores. The findings will provide a new strategy of anesthesia and analgesia management for intraspinal tumor resection.

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“…There were 11 (31%) cases of obvious overdosing of the drug, 10 (91%) of which were due to lidocaine and one (9%) was due to bupivacaine. The three cases of therapeutic intravenous lidocaine infusion involved administration of a total dose of 1.5-2 mg.kg À1 with the highest reported serum lidocaine level of 16 µg.ml À1 [19,30,35]. One case of intravenous injection resulted from the miscalculation of a dose intended for treatment of laryngospasm in a paediatric patient [13].…”

Section: Ropivacaine and Bupivacaine Individually Each Accountedmentioning

confidence: 99%

“…Between December 2017 and May 2020, there were a further 36 cases of LAST reported in 34 peer‐reviewed published articles [6–39]. These data indicated 30% of patients were older than 65 y, and 6% were younger than 5 y. Sixty‐one percent of cases occurred in the hospital; 17% in outpatient surgery centres; and 14% in outpatient clinics (e.g.…”

Section: Clinical Presentationmentioning

confidence: 99%

Updates in our understanding of local anaesthetic systemic toxicity: a narrative review

et al. 2021

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Summary Despite advances in clinical practice, local anaesthetic systemic toxicity continues to occur with the therapeutic use of local anaesthesia. Patterns of presentation have evolved over recent years due in part to the increasing use of ultrasound which has been demonstrated to reduce risk. Onset of toxicity is increasingly delayed, a greater proportion of clinical reports are secondary to fascial plane blocks, and cases are increasing where non‐anaesthetist providers are involved. The evolving clinical context presents a challenge for diagnosis and requires education of all physicians, nurses and allied health professionals about these changing patterns and risks. This review discusses: mechanisms; prevention; diagnosis; and treatment of local anaesthetic systemic toxicity. The local anaesthetic and dose used, site of injection and block conduct and technique are all important determinants of local anaesthetic systemic toxicity, as are various patient factors. Risk mitigation is discussed including the care of at‐risk groups, such as: those at the extremes of age; patients with cardiac, hepatic and specific metabolic diseases; and those who are pregnant. Advances in the changing clinical landscape with novel applications and settings for the use of local anaesthesia are also described. Finally, we signpost future directions to potentially improve the management of local anaesthetic systemic toxicity. The utility of local anaesthetics remains unquestionable in clinical practice, and thus maximising the safe and appropriate use of these drugs should translate to improvements in patient care.

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Perioperative Intravenous Lidocaine Infusion Adverse Reaction: A Case Report

Cited by 10 publications

References 13 publications

Utilization of Intravenous Lidocaine Infusion for the Treatment of Refractory Chronic Pain

Utilization of Intravenous Lidocaine Infusion for the Treatment of Refractory Chronic Pain

<p>Effect of Intravenous Lidocaine on Postoperative Pain in Patients Undergoing Intraspinal Tumor Resection: Study Protocol for a Prospective Randomized Controlled Trial</p>

Updates in our understanding of local anaesthetic systemic toxicity: a narrative review

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