The use of intravenous lidocaine for postoperative pain and recovery: international consensus statement on efficacy and safety

Summary Intravenous lidocaine is used widely for its effect on postoperative pain and recovery but it can be, and has been, fatal when used inappropriately and incorrectly. The risk‐benefit ratio of i.v. lidocaine varies with type of surgery and with patient factors such as comorbidity (including pr...

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Published inAnaesthesia Vol. 76; no. 2; pp. 238 - 250
Main Authors Foo, I., Macfarlane, A. J. R., Srivastava, D., Bhaskar, A., Barker, H., Knaggs, R., Eipe, N., Smith, A. F.
Format Journal Article
LanguageEnglish
Published England Blackwell Publishing Ltd 01.02.2021
Subjects
Online AccessGet full text
ISSN0003-2409
1365-2044
1365-2044
DOI10.1111/anae.15270

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Abstract Summary Intravenous lidocaine is used widely for its effect on postoperative pain and recovery but it can be, and has been, fatal when used inappropriately and incorrectly. The risk‐benefit ratio of i.v. lidocaine varies with type of surgery and with patient factors such as comorbidity (including pre‐existing chronic pain). This consensus statement aims to address three questions. First, does i.v. lidocaine effectively reduce postoperative pain and facilitate recovery? Second, is i.v. lidocaine safe? Third, does the fact that i.v. lidocaine is not licensed for this indication affect its use? We suggest that i.v. lidocaine should be regarded as a ‘high‐risk’ medicine. Individual anaesthetists may feel that, in selected patients, i.v. lidocaine may be beneficial as part of a multimodal peri‐operative pain management strategy. This approach should be approved by hospital medication governance systems, and the individual clinical decision should be made with properly informed consent from the patient concerned. If i.v. lidocaine is used, we recommend an initial dose of no more than 1.5 mg.kg‐1, calculated using the patient’s ideal body weight and given as an infusion over 10 min. Thereafter, an infusion of no more than 1.5 mg.kg‐1.h‐1 for no longer than 24 h is recommended, subject to review and re‐assessment. Intravenous lidocaine should not be used at the same time as, or within the period of action of, other local anaesthetic interventions. This includes not starting i.v. lidocaine within 4 h after any nerve block, and not performing any nerve block until 4 h after discontinuing an i.v. lidocaine infusion.
AbstractList Summary Intravenous lidocaine is used widely for its effect on postoperative pain and recovery but it can be, and has been, fatal when used inappropriately and incorrectly. The risk‐benefit ratio of i.v. lidocaine varies with type of surgery and with patient factors such as comorbidity (including pre‐existing chronic pain). This consensus statement aims to address three questions. First, does i.v. lidocaine effectively reduce postoperative pain and facilitate recovery? Second, is i.v. lidocaine safe? Third, does the fact that i.v. lidocaine is not licensed for this indication affect its use? We suggest that i.v. lidocaine should be regarded as a ‘high‐risk’ medicine. Individual anaesthetists may feel that, in selected patients, i.v. lidocaine may be beneficial as part of a multimodal peri‐operative pain management strategy. This approach should be approved by hospital medication governance systems, and the individual clinical decision should be made with properly informed consent from the patient concerned. If i.v. lidocaine is used, we recommend an initial dose of no more than 1.5 mg.kg‐1, calculated using the patient’s ideal body weight and given as an infusion over 10 min. Thereafter, an infusion of no more than 1.5 mg.kg‐1.h‐1 for no longer than 24 h is recommended, subject to review and re‐assessment. Intravenous lidocaine should not be used at the same time as, or within the period of action of, other local anaesthetic interventions. This includes not starting i.v. lidocaine within 4 h after any nerve block, and not performing any nerve block until 4 h after discontinuing an i.v. lidocaine infusion.
Intravenous lidocaine is used widely for its effect on postoperative pain and recovery but it can be, and has been, fatal when used inappropriately and incorrectly. The risk‐benefit ratio of i.v. lidocaine varies with type of surgery and with patient factors such as comorbidity (including pre‐existing chronic pain). This consensus statement aims to address three questions. First, does i.v. lidocaine effectively reduce postoperative pain and facilitate recovery? Second, is i.v. lidocaine safe? Third, does the fact that i.v. lidocaine is not licensed for this indication affect its use? We suggest that i.v. lidocaine should be regarded as a ‘high‐risk’ medicine. Individual anaesthetists may feel that, in selected patients, i.v. lidocaine may be beneficial as part of a multimodal peri‐operative pain management strategy. This approach should be approved by hospital medication governance systems, and the individual clinical decision should be made with properly informed consent from the patient concerned. If i.v. lidocaine is used, we recommend an initial dose of no more than 1.5 mg.kg ‐1 , calculated using the patient’s ideal body weight and given as an infusion over 10 min. Thereafter, an infusion of no more than 1.5 mg.kg ‐1 .h ‐1 for no longer than 24 h is recommended, subject to review and re‐assessment. Intravenous lidocaine should not be used at the same time as, or within the period of action of, other local anaesthetic interventions. This includes not starting i.v. lidocaine within 4 h after any nerve block, and not performing any nerve block until 4 h after discontinuing an i.v. lidocaine infusion. 리도카인 정맥주사는 수술 후 통증 및 회복에 미치는 효과 로 인해 널리 사용되고 있으나, 부적절한 사용 및 오용 시 치 명적일 수 있으며 실제 치명적인 사례들이 보고되어 왔다. 정 맥내 리도카인의 위험‐이익 비율(risk‐benefit ratio)은 수술 의 종류 및 동반질환(기존의 만성 통증 포함)과 같은 환자 요 인에 따라 달라진다. 본 합의 성명서는 세 가지 질문에 답하 는 것을 목적으로 한다. 첫째, 리도카인 정맥주사는 수술 후 통증을 효과적으로 경감하며 회복을 촉진하는가? 둘째, 리 도카인 정맥주사는 안전한가? 셋째, 이 적응증에 대해 리도 카인 정맥주사 사용이 허가되지 않았다는 사실이 사용에 영 향을 미치는가? 저자들은 리도카인 정맥주사가 ‘고위험’ 의약 품으로 간주되어야 한다고 제안한다. 개별 마취과 전문의는 선택된 환자에서 리도카인 정맥주사가 다각적 주술기 통증 관리 전략(multimodal perioperative pain management strategy)의 일부로서 도움이 된다고 느낄 수 있다. 이러한 접 근은 병원 의약품 관리 시스템의 승인을 받아야 하며, 개별 임상적 의사결정은 해당 환자에게 적절한 정보 제공에 입각 한 동의를 받아 이루어져야 한다. 리도카인 정맥주사를 사용 하는 경우, 환자의 이상 체중(ideal body weight)을 사용하 여 계산한 1.5 mg.kg‐1 이하의 초기 투여량을 10분 동안 주입 하기를 권고한다. 그 이후에는 검토 및 재평가에 따라 1.5 mg.kg‐1.h‐1 이하의 속도로 최대 24시간을 넘지 않도록 주입 하는 것을 권고한다. 리도카인 정맥주사를 다른 국소 마취제 중재와 동시에 또는 해당 중재의 작용 기간 내에 사용해서는 안 된다. 여기에는 모든 신경 차단 시행 후 4시간 이내에 정맥 내 리도카인 주입을 시작하지 않으며 정맥내 리도카인 주입 중단 후 4시간 이내에 모든 신경 차단을 시행하지 않는 것이 포함된다.
Intravenous lidocaine is used widely for its effect on postoperative pain and recovery but it can be, and has been, fatal when used inappropriately and incorrectly. The risk‐benefit ratio of i.v. lidocaine varies with type of surgery and with patient factors such as comorbidity (including pre‐existing chronic pain). This consensus statement aims to address three questions. First, does i.v. lidocaine effectively reduce postoperative pain and facilitate recovery? Second, is i.v. lidocaine safe? Third, does the fact that i.v. lidocaine is not licensed for this indication affect its use? We suggest that i.v. lidocaine should be regarded as a ‘high‐risk’ medicine. Individual anaesthetists may feel that, in selected patients, i.v. lidocaine may be beneficial as part of a multimodal peri‐operative pain management strategy. This approach should be approved by hospital medication governance systems, and the individual clinical decision should be made with properly informed consent from the patient concerned. If i.v. lidocaine is used, we recommend an initial dose of no more than 1.5 mg.kg‐1, calculated using the patient’s ideal body weight and given as an infusion over 10 min. Thereafter, an infusion of no more than 1.5 mg.kg‐1.h‐1 for no longer than 24 h is recommended, subject to review and re‐assessment. Intravenous lidocaine should not be used at the same time as, or within the period of action of, other local anaesthetic interventions. This includes not starting i.v. lidocaine within 4 h after any nerve block, and not performing any nerve block until 4 h after discontinuing an i.v. lidocaine infusion.
Intravenous lidocaine is used widely for its effect on postoperative pain and recovery but it can be, and has been, fatal when used inappropriately and incorrectly. The risk-benefit ratio of i.v. lidocaine varies with type of surgery and with patient factors such as comorbidity (including pre-existing chronic pain). This consensus statement aims to address three questions. First, does i.v. lidocaine effectively reduce postoperative pain and facilitate recovery? Second, is i.v. lidocaine safe? Third, does the fact that i.v. lidocaine is not licensed for this indication affect its use? We suggest that i.v. lidocaine should be regarded as a 'high-risk' medicine. Individual anaesthetists may feel that, in selected patients, i.v. lidocaine may be beneficial as part of a multimodal peri-operative pain management strategy. This approach should be approved by hospital medication governance systems, and the individual clinical decision should be made with properly informed consent from the patient concerned. If i.v. lidocaine is used, we recommend an initial dose of no more than 1.5 mg.kg , calculated using the patient's ideal body weight and given as an infusion over 10 min. Thereafter, an infusion of no more than 1.5 mg.kg .h for no longer than 24 h is recommended, subject to review and re-assessment. Intravenous lidocaine should not be used at the same time as, or within the period of action of, other local anaesthetic interventions. This includes not starting i.v. lidocaine within 4 h after any nerve block, and not performing any nerve block until 4 h after discontinuing an i.v. lidocaine infusion.
Intravenous lidocaine is used widely for its effect on postoperative pain and recovery but it can be, and has been, fatal when used inappropriately and incorrectly. The risk-benefit ratio of i.v. lidocaine varies with type of surgery and with patient factors such as comorbidity (including pre-existing chronic pain). This consensus statement aims to address three questions. First, does i.v. lidocaine effectively reduce postoperative pain and facilitate recovery? Second, is i.v. lidocaine safe? Third, does the fact that i.v. lidocaine is not licensed for this indication affect its use? We suggest that i.v. lidocaine should be regarded as a 'high-risk' medicine. Individual anaesthetists may feel that, in selected patients, i.v. lidocaine may be beneficial as part of a multimodal peri-operative pain management strategy. This approach should be approved by hospital medication governance systems, and the individual clinical decision should be made with properly informed consent from the patient concerned. If i.v. lidocaine is used, we recommend an initial dose of no more than 1.5 mg.kg-1 , calculated using the patient's ideal body weight and given as an infusion over 10 min. Thereafter, an infusion of no more than 1.5 mg.kg-1 .h-1 for no longer than 24 h is recommended, subject to review and re-assessment. Intravenous lidocaine should not be used at the same time as, or within the period of action of, other local anaesthetic interventions. This includes not starting i.v. lidocaine within 4 h after any nerve block, and not performing any nerve block until 4 h after discontinuing an i.v. lidocaine infusion.Intravenous lidocaine is used widely for its effect on postoperative pain and recovery but it can be, and has been, fatal when used inappropriately and incorrectly. The risk-benefit ratio of i.v. lidocaine varies with type of surgery and with patient factors such as comorbidity (including pre-existing chronic pain). This consensus statement aims to address three questions. First, does i.v. lidocaine effectively reduce postoperative pain and facilitate recovery? Second, is i.v. lidocaine safe? Third, does the fact that i.v. lidocaine is not licensed for this indication affect its use? We suggest that i.v. lidocaine should be regarded as a 'high-risk' medicine. Individual anaesthetists may feel that, in selected patients, i.v. lidocaine may be beneficial as part of a multimodal peri-operative pain management strategy. This approach should be approved by hospital medication governance systems, and the individual clinical decision should be made with properly informed consent from the patient concerned. If i.v. lidocaine is used, we recommend an initial dose of no more than 1.5 mg.kg-1 , calculated using the patient's ideal body weight and given as an infusion over 10 min. Thereafter, an infusion of no more than 1.5 mg.kg-1 .h-1 for no longer than 24 h is recommended, subject to review and re-assessment. Intravenous lidocaine should not be used at the same time as, or within the period of action of, other local anaesthetic interventions. This includes not starting i.v. lidocaine within 4 h after any nerve block, and not performing any nerve block until 4 h after discontinuing an i.v. lidocaine infusion.
Author Foo, I.
Srivastava, D.
Bhaskar, A.
Macfarlane, A. J. R.
Eipe, N.
Barker, H.
Knaggs, R.
Smith, A. F.
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  surname: Foo
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  organization: Western General Infirmary
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  surname: Macfarlane
  fullname: Macfarlane, A. J. R.
  organization: Glasgow Royal Infirmary
– sequence: 3
  givenname: D.
  surname: Srivastava
  fullname: Srivastava, D.
  organization: Raigmore Hospital
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  givenname: A.
  surname: Bhaskar
  fullname: Bhaskar, A.
  organization: Imperial College Healthcare NHS Trust
– sequence: 5
  givenname: H.
  surname: Barker
  fullname: Barker, H.
  organization: Ashford and St Peter’s Hospitals NHS Foundation Trust
– sequence: 6
  givenname: R.
  surname: Knaggs
  fullname: Knaggs, R.
  organization: University of Nottingham
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  fullname: Eipe, N.
  organization: Ottowa Hospital
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  givenname: A. F.
  orcidid: 0000-0003-2650-9764
  surname: Smith
  fullname: Smith, A. F.
  email: Andrew.smith@mbht.nhs.uk
  organization: Royal Lancaster Infirmary
BackLink https://www.ncbi.nlm.nih.gov/pubmed/33141959$$D View this record in MEDLINE/PubMed
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Snippet Summary Intravenous lidocaine is used widely for its effect on postoperative pain and recovery but it can be, and has been, fatal when used inappropriately and...
Intravenous lidocaine is used widely for its effect on postoperative pain and recovery but it can be, and has been, fatal when used inappropriately and...
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SubjectTerms Administration, Intravenous
Anesthetics
Anesthetics, Local - administration & dosage
Anesthetics, Local - adverse effects
Anesthetics, Local - therapeutic use
Body weight
Chronic pain
Comorbidity
Consensus
efficacy
Humans
idocaine
Informed consent
Infusions, Intravenous
Intravenous administration
Lidocaine
Lidocaine - administration & dosage
Lidocaine - adverse effects
Lidocaine - therapeutic use
Local anesthesia
Nerve Block
Pain
Pain, Postoperative - prevention & control
Patient Safety
Patients
Postoperative period
Recovery
Recovery (Medical)
Recovery of Function
Risk Assessment
safety
Surgery
Treatment Outcome
Title The use of intravenous lidocaine for postoperative pain and recovery: international consensus statement on efficacy and safety
URI https://onlinelibrary.wiley.com/doi/abs/10.1111%2Fanae.15270
https://www.ncbi.nlm.nih.gov/pubmed/33141959
https://www.proquest.com/docview/2476330107
https://www.proquest.com/docview/2457668458
Volume 76
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