Lidocaine infusions

[epidural man]

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My brother who is an anesthesiology resident at U of Virginia uses them all the time. They have a guy there who has written a lot of the literature on the subject (Durieux ME).

What do you guys think? Do you use a lidocaine infusion? What are the downsides and when would you want/not want to use it.

I have never seen it done.

 

[Planktonmd]

My brother who is an anesthesiology resident at U of Virginia uses them all the time. They have a guy there who has written a lot of the literature on the subject (Durieux ME).

What do you guys think? Do you use a lidocaine infusion? What are the downsides and when would you want/not want to use it.

I have never seen it done.

Are you talking about Lidocaine infusions for chronic pain?
This used to be done for things like Post Herpetic Neuralgia then switched to the Oral form "Mexiletine". The evidence on this practice is weak.
If you mean Lidocaine infusions for GA, this is a good technique, not very common but it definitely reduces the need for other anesthetics and is particularly attractive for cases that don't require long acting stuff and where rapid emergence is desirable (Carotids for example).

 

[milrisome]

(having no experience myself) Do you mean they don't emerge rapidly after lidocaine infusion?

 

[Planktonmd]

(having no experience myself) Do you mean they don't emerge rapidly after lidocaine infusion?

Oh, I meant they emerge rapidly, Sorry for the confusion.

 

[milrisome]

The latest study I saw regarding this had them on the lidocaine infusion for 24 hours postop. I got pretty nervous when I saw this b/c I could imagine this easily going bad. Do you have any experience here?

 

[Planktonmd]

The latest study I saw regarding this had them on the lidocaine infusion for 24 hours postop. I got pretty nervous when I saw this b/c I could imagine this easily going bad. Do you have any experience here?

I haven't done post op Lidocaine Infusions because of the same fear you mentioned 🙂

 

[milrisome]

Amazing what you can get away with in a randomized controlled trial!

 

[tussionex]

we still see mexilitine for post-herpetic neuralgias and other neuropathies, but only once in a while.

 

[dhb]

I know a hospital that routinely uses lidocaine/ketamine infusions for post-op pain they published this study among others:
http://www.ncbi.nlm.nih.gov/sites/e...ez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
The guy Durieux is actually from that group in Belgium.
I don't have experience with it either but i think they have some kind of special surveillance for these patients...

 

[jwk]

If you're talking about lidocaine infusions for chronic pain - voodoo.

 

[Noyac]

I know a hospital that routinely uses lidocaine/ketamine infusions for post-op pain they published this study among others:
http://www.ncbi.nlm.nih.gov/sites/e...ez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
The guy Durieux is actually from that group in Belgium.
I don't have experience with it either but i think they have some kind of special surveillance for these patients...

These people were in the hospital for 48 hrs after a Lap. Chole. I appreciate the study but doesn't that seem like a long time for a simple case? Its at least 24 hrs longer than our pts stay unles there are other comorbidities which warrant their stay.

 

[VentdependenT]

If you're going to be looking to IV lido infusions and aren't practicing medicine in the 1960's then you should probably should be looking toward other membrane stabilizers first....and foremost.

Gabapentin
oxcarbazepine
lamotrigene
topirimate
lamictal
zonegran
keppra

Come to mind. Yeah they take a week or two to get up to speed but you're gonna need something for long term and lido ggt's just aint gonna do it.

 

[dhb]

These people were in the hospital for 48 hrs after a Lap. Chole. I appreciate the study but doesn't that seem like a long time for a simple case? Its at least 24 hrs longer than our pts stay unles there are other comorbidities which warrant their stay.

In Europe people stay longer in the hospital...

 

[epidural man]

I was talking about lidocaine as an infusion during GA.

Apparently, Durieux ME is at U of VA now. According to my brother, they run the infusion during the case and during extubation and sometimes for 2 hrs in the PACU.

Here is a very recent paper that describe similar techniques.

Systemic Lidocaine Shortens Length of Hospital Stay after Colorectal Surgery: A double-blinded, randomized, placebo-controlled trial. Ann Surg. 2007 Aug:246(2);192-200