Lidocaine infusions and Eras

[narcusprince]

New to running eras protocols. Wanted to know when doing ERAS cases when do you turn off your lidocaine infusions? And do you ever turn off the lidocaine based on total dosing given to patient? Would you offer those patients tap blocks. Dosing runs between 20-40mcg/kg/min. Thx

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[Psai]

You can keep running it while you're in pacu

 

[DM27]

I used to run it in PACU at another job. Currently I just turn it off in the minutes approaching extubation.

 

[narcusprince]

And TAP blocks with lido infusions?

 

[dhb]

And TAP blocks with lido infusions?

I don't see the point.
Just do a TAP block and skip the infusion nonsense.

 

[Ronin786]

I turn off my lidocaine infusions when I meet the patient in pre-op.

 

[fathead888]

We cut it off 30mins prior to extubation and don't run them if they received TAP blocks or any other regional/fascial plane block. We run them at 1.5 mg/kg/hr IBW so it ends up being 100 mg/hr approx. If they get 40cc of 0.25% bupi for the block + 100 mg lidocaine for induction any additional has gotta be supratherapeutic. If they received intrathecal opioid though we run the lidocaine.

 

[Bru]

1mg/kg/hr IBW during case starting soon after induction (with lido given at that point usually). Stop 30 mins before block particularly if using Exparel. If no block, usually stop 15 mins before extubation.

 

[anesthesiadoc]

we've been stopping with about an hour left in the surgery. This is after multiple iterations and some slow wakeups when we kept it going until emergence.

 

[AdmiralChz]

we've been stopping with about an hour left in the surgery. This is after multiple iterations and some slow wakeups when we kept it going until emergence.

We have had the same experience, some of our emergencies have been exceedingly slow with longer lidocaine infusions. We don’t do intathecal meds or TAP blocks, though (only ERAS for robot cases, for now)

 

[T-burglar]

next time you have back pain inject yourself with 80 mg of lidocaine and feel the palpitations, perioral paresthesia, loss of coordination, and lack of analgesia.

then stop giving it to your patients.

 

[Psai]

next time you have back pain inject yourself with 80 mg of lidocaine and feel the palpitations, perioral paresthesia, loss of coordination, and lack of analgesia.

then stop giving it to your patients.

Maybe u need a cardiac workup?

 

[Planktonmd]

That whole Lidocaine infusion business is stupid in my humble opinion. Some people cannot understand the difference between multi-modal analgesia and stupid polypharmacy.

 

[T-burglar]

we've been stopping with about an hour left in the surgery. This is after multiple iterations and some slow wakeups when we kept it going until emergence.

We had a patient take like 16 hours to wake up once after one of these ridiculous lido ketamine opioid propofol anesthetics that people are trying

 

[Psai]

We had a patient take like 16 hours to wake up once after one of these ridiculous lido ketamine opioid propofol anesthetics that people are trying

I find that hard to believe

 

[anbuitachi]

We had a patient take like 16 hours to wake up once after one of these ridiculous lido ketamine opioid propofol anesthetics that people are trying

I find that hard to believe

i can see it if a long case and ran high dose fentanyl infusion. dont forget to add precedex infusion , and +/- magnesium if no ketamine!

Unless the attending tells me to add a bunch of infusions, the only additional infusions i do for certain cases is ketamine. i dont think the benefit of lidocaine infusion or precedex infusion is really worth it

 

[deleted162650]

We had a patient take like 16 hours to wake up once after one of these ridiculous lido ketamine opioid propofol anesthetics that people are trying

Yes but pain control was EXCELLENT!

The pt used 0mg of morphine for the first 16hrs post-op!

 

[anbuitachi]

Yes but pain control was EXCELLENT!

The pt used 0mg of morphine for the first 16hrs post-op!

mission accomplished?

 

[NightNight]

everybody always wants to bash lido

It’s well studied and obviously provides benefit, as do ERAS protocols

If you’re having slow wake ups it’s not the lido

Routinely run lido 1-2mg/min intraop and in PACU, even if I do TAPs

 

[anbuitachi]

everybody always wants to bash lido

It’s well studied and obviously provides benefit, as do ERAS protocols

If you’re having slow wake ups it’s not the lido

Routinely run lido 1-2mg/min intraop and in PACU, even if I do TAPs

is there much benefit to Lido infusion on TOP of bupi blocks?

 

[dhb]

Routinely run lido 1-2mg/min intraop and in PACU, even if I do TAP

Why?

 

[T-burglar]

I don’t care what the studies show. IV lidocaine provides less analgesia than acupuncture . There is so much garbage science being published

 

[NightNight]

is there much benefit to Lido infusion on TOP of bupi blocks?

If surgery is long-ish, I don’t waste a couple hours of the TAP blocks intraop. Lidocaine infusion intraop reduces MAC and opioid need, end of case pop in TAPs just before wake up.

If the patient has a liver that even marginally works, there is no toxicity risk