Elizabeth Nam
Clinical Pharmacy Specialist - Emergency Medicine
Loma Linda University Medical Center
Loma Linda, California
Disclosure information not submitted.
Sharon Jung, BCCCP, PharmD
Critical Care Clinical Pharmacist
Loma Linda University Medical Center
Loma Linda, California, United States
Disclosure information not submitted.
Nam Cho, BCPS, PharmD
Clinical Pharmacy Specialist - Medical ICU
Loma Linda University Medical Center, United States
Disclosure information not submitted.
Thomas Bushell, PharmD
Clinical Pharmacy Specialist - Surgical ICU
Loma Linda University Medical Center, United States
Disclosure information not submitted.
Title: Intravenous Lidocaine Infusion for the Treatment of Pain in Critically Ill Patients
Introduction/Hypothesis: Pain management is a key component of optimizing patient care in the critical care setting with opioids being the mainstay of therapy. Given the growing concerns regarding the opioid epidemic and safety of their use, there has been a shift in practice to support opioid-sparing and multi-modal analgesia. Recent studies support the use of intravenous lidocaine infusion as an alternative or adjunctive therapy to optimize analgesia and potentially decrease opioid requirements. However, concerns regarding lidocaine toxicity may limit its systemic use. This study aims to better understand the efficacy and safety of intravenous lidocaine infusion for the treatment of pain in critically ill patients.
Methods: This retrospective, single center study evaluated the use of intravenous lidocaine infusion as an analgesic in patients admitted to the Surgical Intensive Care Unit (SICU) from August 2019 to November 2020. The primary outcome was the difference in opioid requirements, measured in morphine milligram equivalents (MME), in patients with and without the use of intravenous lidocaine infusion for pain. Secondary outcomes included incidences of adverse drug events, duration of mechanical ventilation, lidocaine levels, length of stay, and inpatient mortality.
Results: Sixty-four patients were included where 19 patients received lidocaine in addition to standard of care and 45 patients received standard of care. The lidocaine group exhibited a decrease in median opioid requirements post infusion while the standard of care group had no change in requirements -22.6 MME (-64.3, 0.6) vs 0 MME (-9.4, 8.3); p=0.03. Intravenous lidocaine was also found to significantly decrease the median duration of mechanical ventilation 0.5 (0, 5.9) vs 4.2 (2.0, 10.9); p=0.03. Three patients were found to have supratherapeutic lidocaine levels but did not experience adverse events. There were no significant differences in adverse drug events, time to SICU admission, hospital/ICU lengths of stay, or inpatient mortality.
Conclusions: Intravenous lidocaine infusion for pain resulted in decreased opioid analgesic requirements in critically ill patients with minimal risk of adverse effects and was associated with a decreased number of ventilation days.