In this section
Administration of intravenous lignocaine infusion is indicated as an adjunctive intervention in patients with severe acute pain eg during and post laparotomy, following major trauma or burns and for acute cancer pain flares or neuropathic (nerve memory) pain [such as deafferentation/postamputation pain or from acute spinal cord injury, polyneuropathy] that has not responded to other interventions.
Usual procedure length - 2-72 hours
Is required prior to the administration of lignocaine.
The usual bolus dose is 1-2mg/kg over 1-2 minutes with a subsequent lower intra-operative infusion rate of 17-25mcg/kg/min ( equating to 1 to 1.5mg/kg/h in an adult patient) that may be continued into the post-operative period for 6-72h ( Vigneault, Turgeon et al. 2011, Sun, Li et al. 2012, Barreveld, Witte et al. 2013).
Non-invasive Blood pressure (NIBP) and pulse oximeter monitoring. Continuous (if available) or intermittent measurements acceptable
Vital signs and pain scores hourly (age appropriate) at baseline and then repeat hourly for first 6 hours.Thereafter 4 hourly or earlier if side effects reported.
During the administration of IV lignocaine, if nursing or medical staff are concerned at anytime -
Potential side effects-lightheadedness, dizziness, slurred speech, nystagmus, allergy to local anesthetic (rare)
Barreveld, A., J. Witte, H. Chahal, M. E. Durieux and G. Strichartz (2013). "Preventive analgesia by local anesthetics: the reduction of postoperative pain by peripheral nerve blocks and intravenous drugs." Anesth Analg116(5): 1141-1161.
Challapalli, V., I. W. Tremont-Lukats, E. D. McNicol, J. Lau and D. B. Carr (2005). "Systemic administration of local anesthetic agents to relieve neuropathic pain." Cochrane Database Syst Rev(4): CD003345.
Edwards, T. W., F. Habib, R. G. Burney and G. Begin (1985). "Intravenous Lidocaine in the Management of Various Chronic Pain States: A Review of 211 Cases." Regional Anesthesia 10(1): 1-6.
Kalso, E., M. R. Tramer, H. J. McQuay and R. A. Moore (1998). "Systemic local-anaesthetic-type drugs in chronic pain: a systematic review." Eur
J Pain 2(1): 3-14.
Kosharskyy, B., W. Almonte, N. Shaparin, M. Pappagallo and H. Smith (2013). "Intravenous infusions in chronic pain management." Pain Physician16(3): 231-249.
Sun, Y., T. Li, N. Wang, Y. Yun and T. J. Gan (2012). "Perioperative systemic lidocaine for postoperative analgesia and recovery after abdominal surgery: a meta-analysis of randomized controlled trials." Dis Colon Rectum 55(11): 1183-1194.
Tremont-Lukats, I. W., V. Challapalli, E. D. McNicol, J. Lau and D. B. Carr (2005). "Systemic administration of local anesthetics to relieve neuropathic pain: a systematic review and meta-analysis." Anesth Analg 101(6): 1738-1749.
Vigneault, L., A. F. Turgeon, D. Cote, F. Lauzier, R. Zarychanski, L. Moore, L. A. McIntyre, P. C. Nicole and D. A. Fergusson (2011). "Perioperative intravenous lidocaine infusion for postoperative pain control: a meta-analysis of randomized controlled trials." Can J Anaesth 58(1): 22-37.