Residents and Fellows Research in Progress
Monday, November 13, 2023
01:00 PM–02:30 PM
Abstract
Introduction:
Intravenous (IV) lidocaine has been used as an adjunct therapy for pain management in a variety of clinical settings. Recent studies assessing the analgesic efficacy of IV lidocaine have yielded conflicting results regarding its impact on opioid requirements, pain scores, and quality of life. Furthermore, IV lidocaine may cause neurological and cardiovascular adverse effects, and its routine use is not recommended for pain management in critically ill patients.
Research Question or Hypothesis: The goal of this study is to investigate the efficacy and safety of IV lidocaine as an adjunct therapy for acute pain management.
Study Design: Retrospective, single center, one-group pre/post quasi-experimental study over one year.
Methods: All patients meeting inclusion criteria were admitted for =24 hours before and after IV lidocaine was initiated for pain control, while patients using patient-controlled analgesia (PCA) pumps were excluded. The primary endpoint was the difference in the total average morphine milligram equivalents (MMEs) administered during the 24-hour periods directly before and after the initiation of IV lidocaine. The change in 24-hour median pain score and the incidence of lidocaine-related adverse effects were also assessed. The primary outcome was analyzed using the Wilcoxon Signed-Rank test with a p-value = 0.05 considered statistically significant using SAS software.
Results: Ninety patients were included. There was no significant difference in 24-hour MME requirements (131.6 vs. 133.7; P = 0.93) before and after lidocaine was initiated, however, median pain scores were significantly lower (8.0 vs. 7.0; P < 0.01) following lidocaine initiation. Six patients (6.7%) experienced lidocaine-related adverse effects, which were mostly neurological.
Conclusion: An opioid-sparing effect of IV lidocaine was not observed, however, IV lidocaine provided a modest benefit in acute multimodal pain control for hospitalized patients. The clinical significance of this benefit is unknown.
Presenting Author
Michael Laskowitz Pharm.D.Carilion Roanoke Memorial Hospital
Authors
Benjamin Gustafson Pharm.D.
Norton Women's and Children's Hospital
Robert Howitt PharmD, BCPS
Tamara Davidson Pharm.D., BCPS
Bridgette Smigiel Pharm.D., MS