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

Abstract

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.

Efficacy of Dry Needling and Acupuncture in the Treatment of Neck Pain

“…In trying to avoid opioid use, cannabis has also been gaining recognition in the treatment of chronic pain (24). Infusion therapy may also include options such as ketamine, lidocaine, magnesium, and dexmedetomidine (25)(26)(27)(28)(29)(30), while considering possible side effects, such as toxicity, addiction, and psychosocial harm (31,32). Invasive interventions such as surgery, radiofrequency ablation, surgical, root injections, epidural injections, are not recommended unless patients have neck pain associated with structural disruption or radiculopathy (20,22,33).…”

Intraoperative Hypotension Increased Risk in the Oncological Patient

“…The anesthesia team and preoperative/recovery room nurses are asked to monitor and manage each patient's physiology preoperatively (5)(6)(7)(8). This management should maintain the patient's physiological parameters within their normal range.…”

A Comparative Study of Valsalva Maneuver, Lidocaine, and Valsalva Maneuvers with Administration of Lidocaine to Reduce the Pain Associated with Administration of Etomidate During General Anesthesia

“…It has also been used in patients suffering from Cushing's syndrome in the form of an offlabel drug in order to suppress the production of steroids. Lidocaine is classically considered a local anesthetic but is now becoming more widely used for systemic analgesia (9).…”

“…logical method which has been used to lower pain in different procedures (9,10). The Valsalva maneuver reduces both somatic and physiological aspects of painful procedures (8,9).…”

“…logical method which has been used to lower pain in different procedures (9,10). The Valsalva maneuver reduces both somatic and physiological aspects of painful procedures (8,9). The Valsalva maneuver is very effective and useful in reducing pain because it is easily applicable and physiologically effective, time and cost effective, painless, without side effects and compatible with the patient, which can be effective in reducing pain in patients who refuse medication.…”