Lidocaine Infusion

@Gas_Craic

Have you considered an IV infusion?

CAUTIONS

First and second degree heart conduction blocks could be aggravated and progress into a higher degree of heart block with lidocaine administration.

Cardiovascular instability and concomitant use of alpha agonists (e.g., clonidine) or beta blockers (e.g., metoprolol, labetolol) are relative contraindications. Allergies to other amide local anesthetics (bupivacaine).

Mild side effects always occur first as an early warning of lidocaine toxicity. If left unchecked side effects can progress to seizures, cardiovascular collapse and death

Half‐life of lidocaine is 1 to 1.5 hours, which means the side effects typically dissipate within this time frame after stopping an infusion. The analgesic effect of lidocaine may last longer than the pharmacologic half‐life.

• Mild (at serum levels 3‐8 mcg/mL) numbness and tingling in the fingers and toes, numbness and unusual sensations around the mouth, a metallic taste in the mouth, ringing in the ears, or lightheadedness and dizziness

• Moderate side effects (at serum levels 8‐12 mcg/mL) includes mild side effects with the addition of nausea and vomiting, severe dizziness, decreased hearing, tremors, changes in blood pressure and pulse. Nausea and vomiting without other lidocaine side effects in the postoperative setting is unlikely to be related to the lidocaine.

• Severe side effects (at serum levels greater than 12 mcg/mL) drowsiness confusion, muscle twitching, convulsions, loss of consciousness, cardiac arrhythmias, cardiac arrest.

BOLUS!

Then.. continuous infusion

Toxicity Warnings

Pharmacology

Amide local anaesthetic. Slows down the depolarization of the nerve cell membrane. This effect is based on the interaction with a specific receptor site in the sodium channel. Reduces the automaticity in the conductive system of the heart by slowing down the diastolic depolarization. Lidocaine can have a stimulating or a sedative effect on the central nervous system. Thought to desensitise the central nervous system in chronic pain patients.

Why?

Monitoring During

IV lignocaine may* have benefit in perioperative pain.

IV lignocaine may be indicated as an adjunct to systemic opioids for surgical pain when other multimodal approaches such as regional analgesia are not possible. ALSO used in chronic pain!

Continuous ECG, BP, Sats &

Neuro-Obs if patient awake- usually done in a very observed environment like theatre/OP clinic

1.5mg/kg bolus

70kg pt = 105mg bolus

(some clinics use 1mg/kg bolus first)

2mg//kg/hr --> (70kg) = 140mg/hr intra-op, then 1.33mg/kg in the recovery suite for as long as
you can manage! (a lot of wards won't accept)

See below for cautions. It is rare for side effects to occur at serum levels between 2-6ml/L. STOP the infusion if you are concerned and always know where 'Intralipid' is kept.

LIGNOCAINE

Dr. David Lyness

LOADING AWESOME

Toxicity

*http://prc.coh.org/FF%20LidoIVPer12-10.pdf

www.propofology.com

Other uses are possible like in ED - opioid sparing etc. Could have wide-impacting clinical uses

Lidocaine Infusion

David Lyness | March 08, 2020