Lidocaine IV Infusion for pain.

[NDcienporciento100]

I have a friend that was given a lidocaine infusion for ongoing back pain he has had for years By a PM&R Doctor. Is there any clinical trials looking at this showing benefit? Because it sounds about as smart as Trumps cure Covid with hand sanitizer idea.

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[j4pac]

Injecting meds IV that are part of the ACLS algorithm cause me a little anxiety.

 

[PMR2008]

IV Lidocaine has been used for years. I got exposed to it during fellowship training. I was a little nervous covering the infusion center but most patients really tolerated it well.

Pain Management Treatment and Specialists

Pain Management at UW Health uses a variety of specialists and treatments to help people dealing with pain resulting from an injury, recovery from surgery.

www.uwhealth.org

Treatments

Lidocaine is used to numb the skin and to treat certain heart and pain conditions. Learn about using lidocaine for pain with facts from UW Health.

patient.uwhealth.org

Lidocaine Infusion: A Promising Therapeutic Approach for Chronic Pain

Lidocaine Infusion: A Promising Therapeutic Approach for Chronic Pain

Opioid abuse is a national epidemic in the United States, where it is estimated that a prescription drug overdose death occurs every 19 minutes. While opioids are highly effective in acute and subacute pain control, their use for treatment of chronic ...

www.ncbi.nlm.nih.gov

Intravenous lidocaine in central pain: a double-blind, placebo-controlled, psychophysical study

Intravenous lidocaine in central pain: a double-blind, placebo-controlled, psychophysical study - PubMed

Systemic lidocaine can induce a significant and selective reduction of several components of pain caused by CNS injuries. The observed preferential antihyperalgesic and antiallodynic effects of this drug suggest a selective central action on the mechanisms underlying these evoked pains.

pubmed.ncbi.nlm.nih.gov

Intravenous lidocaine relieves spinal cord injury pain: a randomized controlled trial

Intravenous lidocaine relieves spinal cord injury pain: a randomized controlled trial - PubMed

Lidocaine reduced neuropathic pain at and below the level of injury irrespective of the presence or absence of evoked pain. Results are consistent with a central-acting effect of sodium channel blockers acting on neuronal hyperexcitability. Agents (such as anticonvulsants or antiarrhythmics)...

pubmed.ncbi.nlm.nih.gov

Effect of intravenous lidocaine on the neuropathic pain of failed back surgery syndrome

Effect of intravenous lidocaine on the neuropathic pain of failed back surgery syndrome - PubMed

This study shows that 1 mg/kg, or 5 mg/kg of IV lidocaine, and palcebo was effective in patients with neuropathic pain attributable to FBSS, but effect of licoaine did not differ from placebo saline.

pubmed.ncbi.nlm.nih.gov

 

[NDcienporciento100]

There is 18 patients in that study. Hmmmmmm I’m not sure about this... Just saying!!

 

[PMR2008]

It is good to be skeptical. I didn't do a thorough research on what other evidence is out there. I am sure you can do that. Just to be clear I am not a fan and I do not recommend it to my patients unless everything else has failed. My point was to show you that has been studied and some academic hospitals offer it.

 

[j4pac]

There is 18 patients in that study. Hmmmmmm I’m not sure about this... Just saying!!

Some of the better pain studies I’ve seen in years!!! Lol. Just kidding...well not really

 

[cluelessmedstudent411]

Anesthesiology resident here:

This is very commonly done in the OR as a multimodal analgesia regimen. It is also commonly managed by Acute pain services (Anesthesia subspecialty) for inpatient chronic opioid users.

While it has been beneficial, there is a lot of misuse out there similar to "ketamine clinics". I personally know of a new EM grad that opened up an infusion clinic (ketamine, lidocaine, banana bag) who didn't know what intralipid was....

That is wildly negligent!!!! Its like opening up trauma center with no access to blood.

The clinic was basically run be RN that placed the IV and NP that gave the infusion.

So if you're gonna do it, should be done properly.

 

[j4pac]

Anesthesiology resident here:

This is very commonly done in the OR as a multimodal analgesia regimen. It is also commonly managed by Acute pain services (Anesthesia subspecialty) for inpatient chronic opioid users.

While it has been beneficial, there is a lot of misuse out there similar to "ketamine clinics". I personally know of a new EM grad that opened up an infusion clinic (ketamine, lidocaine, banana bag) who didn't know what intralipid was....

That is wildly negligent!!!! Its like opening up trauma center with no access to blood.

The clinic was basically run be RN that placed the IV and NP that gave the infusion.

So if you're gonna do it, should be done properly.

What kind of monitoring do you typically have in place?

 

[NDcienporciento100]

What kind of monitoring do you typically have in place?

That costs extra lol

 

[cluelessmedstudent411]

What kind of monitoring do you typically have in place?

My personal experience has only been in-patient setting. If I were to come up with a system for outpatient infusion clinic type setting, I would do the following:

- Pre-infusion: EKG
- During infusion: continuous 3 lead telemetry, pulse ox, and BP monitoring
- Post-infusion: monitoring for min 30mins with post-infusion EKG
- You would need all the necessary items for complications: 1) Cardiac complications - Intralipid, ACLS skills/equipment; 2) CNS complications - Intralipid, IV benzodiazepines for seizures, skills to provide airway support (Dont need intubation just BMV should be adequate)
- RN monitoring

Just things off the top of my head.

If you charged like $300+ cash per infusion (usually last 1hr), you could make money. These infusions tend to be in batches of 3 one week apart. You could charge $900 for 1 full round of treatment. It only works out financially/liability wise if you have enough patients for all the equipment/personnel cost.