Stepping out of the box

[ForamenMagnumPI]

A few weeks ago, I cared for a patient with disfiguring neck cancer and intractable pain despite 3 titrated opioids, gabapentin, and high-dose dexamethasone.
Nearing desperation, I tried a bolus of lidocaine 100 mg IV over 20 minutes. In that 20 minutes, the patient's pain level dropped from 8/10 to 2/10. He has done well since.
This experience has caused me to wonder if other clinicians have had similar experiences in which thinking outside the box paid dividends.
Anyone care to share?

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[tiotropium]

Was that your first time using IV lidocaine for pain?

 

[ForamenMagnumPI]

I've used mexilitine a few times, with less than exciting results. This was my first time with IV lidocaine, but I talked with several colleagues before starting this. The results were pretty encouraging.

 

[deleted185747]

I use iv lidocaine all the time. It works well for myofascial pain