Lidocaine infusions for pain

From Anesthesiology 2017

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.

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Open Access Journals, Jan 2017. Lidocaine Infusion: A Promising Therapeutic Approach for Chronic Pain.

Anesthesiology, April 2017. Perioperative use of IV lidocaine.

From ASRA May 2017: Clinical Implications of IV Lidocaine Infusion in Preoperative/ Acute Pain Settings

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.

From Jama Surgery 2017

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