Chelsea Lopez, BCCCP, PharmD
Clinical Pharmacy Specialist
Houston Methodist Hospital
Houston, Texas
Disclosure information not submitted.
Mahmoud Sabawi, PharmD,
Clinical Pharmacy Specialist
Houston Methodist Hospital, United States
Disclosure information not submitted.
Luma Succar, PharmD, BCCCP
Clinical Pharmacy Specialist
Houston Methodist Hospital, United States
Disclosure information not submitted.
Faisal Masud, MD, FCCM
Professor of Clinical Anesthesiology
Houston Methodist Hospital, United States
Disclosure information not submitted.
Hina Faisal, MD; MRCS; M.B;B.S
Assistant Professor of Clinical Surgery, Anesthesiologist & Critical Care Physician
Houston Methodist Hospital
Houston, Texas, United States
Disclosure information not submitted.
Title: Systemic Lidocaine Infusion for Acute Pain Management in a Surgical Intensive Care Unit
Introduction: Acute pain management remains challenging for critical care physicians, anesthesiologists, and surgeons. Evidence has shown that 90% of patients in the intensive care unit are usually treated with opioids for pain. Poorly controlled pain and opioid-related adverse events have several negative consequences for critically ill patients. Multimodal analgesia, and deviation from the traditional opioid-based pain control method, continues to evolve. The objective of this review was to evaluate the safety and efficacy of adjunct lidocaine infusions for pain management.
Methods: In this retrospective chart review, 23 patients received intravenous lidocaine for pain control per our institution-based protocol. The patient's demographic data, vital signs, lidocaine indication, dose, duration, therapeutic drug levels, pain scores, and concomitant opioid and non-opioid analgesic agents were assessed.
Results: Lidocaine infusion was utilized for acute post-operative (n=11), acute on chronic (n=5), and chronic (n=3) pain. The median duration of therapy, dose, and lidocaine levels were 22.5 hours, 20 mcg/kg/min, and 2.79 mcg/mL, respectively, with only two instances of supratherapeutic levels and no notable changes in vital signs. Lidocaine infusion resulted in a 5-point median reduction in pain on the respective pain rating scales. The median time to return of bowel function in post-surgical patients was five days, and 17% of patients had emesis. No major adverse effects were reported. The most common concomitant analgesic therapies were acetaminophen (83%), opioids (70% with median morphine milliequivalent of 33), and gabapentinoids (35%).
Conclusions: Lidocaine doses between 10 and 20 mcg/kg/min resulted in favorable pain control in various conditions when used in conjunction with other analgesic agents. Monitoring lidocaine levels allows for proactive intervention and rate reduction, which is essential in preventing toxicity associated with drug accumulation. Like other available literature, our review suggests that lidocaine may be a safe and effective adjunct agent for pain management in critically ill surgical patients. Further studies are needed to elucidate the association of lidocaine levels with efficacy and safety and further explore lidocaine's potential opioid-sparing effect.