ASRA.com: Clinical Implications of IV Lidocaine Infusion in Preoperative/ Acute Pain Settings. May 2017.
BJA Educ, April 2016. Intravenous lidocaine for acute pain: an evidence-based clinical update
Lidocaine Infusion for Perioperative Pain Management – Vanderbilt
Cocharane Library, July 2015. Continuous intravenous perioperative lidocaine infusion for postoperative pain and recovery.
Perioperative Use of Intravenous Lidocaine. Anesthesiology 4 2017, Vol.126, 729-737.
Open Access Journals, Jan 2017. Lidocaine Infusion: A Promising Therapeutic Approach for Chronic Pain.
Anesthesiology, April 2017. Perioperative use of IV lidocaine.
ClinicalTrials.gov: Effect of IV Lidocaine Infusions on Pain
Here’s what I’m currently using:
- October 2017
- Lidocaine bolus: 1.5mg/kg on induction
- Infusion: 2-3mg/kg/hr after induction to end surgery
- If cardiac on CPB: bolus 1.5mg/kg on induction; Infusion: 4 mg/min x 48 hrs or discharge from ICU; On CPB bolus 4 mg/kg.
- July 2019
- I am currently not using lidocaine infusions as my open heart patients are getting great relief with ketamine. I also came across some literature that said lidocaine infusions do not help postoperative cognitive decline. However, I may reassess this at a later time and reinstitute. We do not currently have an acute pain service. Look at the ASRA, May 2017 issue, I do like the dosing regimen used at UVA. See below.
In our institution, an infusion rate of 40 mcg/kg/min after 1–1.5 mg/kg bolus is used perioperatively as part of our ERAS protocols. The infusion rate is decreased to 5–10 mcg/kg/min at the end of the surgery and continues at the same rate until POD 2. Our acute pain management lidocaine infusion protocol uses a 0.5 mg/min starting dose with a maximum of 1 mg/min for adults, and doses between 15 to 25 mcg/kg/min for pediatric patients <40m kg.
I’m also currently working on ERAS protocols for my practice as well as the use of ketamine infusions for intraoperative and postoperative pain and recovery.