First and second degree heart conduction blocks could be aggravated and progress into a higher degree of heart block with lidocaine administration.
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.
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
70kg pt = 105mg bolus
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.
Dr. David Lyness