Lidocaine drip?

  1. 0
    Have you ever given a Lido drip to treat pts c/o pain from Shingles? if so, what's the dose? Today I had a pt with shingles who was getting no relief after dilaudid, neurontin and morphine. The doc wanted to give a Lido drip ( I guess he's done it once in the past), but he couldn't remember the dose nor he could find any info from Pharmacy/ICU/PDR.
    Thanks
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  3. 6 Comments so far...

  4. 0
    Quote from gabsev
    Have you ever given a Lido drip to treat pts c/o pain from Shingles? if so, what's the dose? Today I had a pt with shingles who was getting no relief after dilaudid, neurontin and morphine. The doc wanted to give a Lido drip ( I guess he's done it once in the past), but he couldn't remember the dose nor he could find any info from Pharmacy/ICU/PDR.
    Thanks

    i've only ever used lido gtts for VT. if this shingles thing is in fact a usage in practice, fill me in... cause it sounds weird.
  5. 0
    Here's what I found about it from the American Herpes Foundation...hope it helps...


    Abstracts from the Recent Literature
    Can Low-Dose IV Lidocaine Reduce the Ongoing Pain and Pain from
    Light Touch of Refractory PHN?

    A trial of intravenous lidocaine on the pain and allodynia of postherpetic neuralgia.
    Baranowski AP, De Courcey J, Bonello E. J Pain Symptom Manage. 1999;17:429-433.

    ABSTRACT
    Background and Objectives
    An IV infusion of lidocaine has been frequently used to produce analgesia in neuropathic pain. Low doses of lidocaine are less likely to produce complications while remaining clinically useful in reducing pain. Thus, the aim of the study was to determine whether low doses of lidocaine have an analgesic effect in patients with PHN, and whether they could reduce not only episodes of ongoing pain but also the evoked pain and the area of allodynia (pain from light touch).

    Goals of the Study
    To investigate the effect of IV lidocaine at 2 doses (1 mg/kg and 5 mg/kg over 2 hours) and IV saline placebo on the pain and allodynia of PHN.

    Study Design
    Twenty-four elderly patients with refractory PHN for longer than 1 year were studied using a randomized, double-blind, within patient crossover design. Each patient received normal saline, lidocaine 0.5 mg/kg/hr, and lidocaine 2.5 mg/kg/hr over a 2-hour period, at least 1 week apart. Free plasma lidocaine levels, the McGill Pain Questionnaire Short Form, visual analog scores (VAS),
    and area of allodynia were measured three times prior to, and at 15-minute intervals during, the infusions.

    Results
    The VAS for ongoing pain showed a significant reduction after all three infusions (P < 0.05). For dynamic pressure-provoked pain, the VAS was unaffected by placebo but showed a reduction at an equal level of significance with both lidocaine infusions (P < 0.05). The area of allodynia of PHN, as mapped by camel hair brush stroke, declined in association with IV lidocaine (0.5 mg/kg/h, P < 0.05; 2.5 mg/kg/h, P < 0.001). Placebo had no significant effect on the area of allodynia.

    Conclusion
    These findings demonstrate a positive effect on pain and allodynia following a brief IV infusion of low-dose lidocaine. Since the elderly often have significant cardiovascular pathology, 1 mg/kg over 2 hours is preferred. The higher-dose infusion may produce plasma levels in the toxic range with no significant clinical increase in response.

    COMMENTARY
    The patients treated in this study had suffered from PHN for an average of 3.25 years. Many treatments had been tried, but none had worked. Therefore, it is exciting to find that low-dose lidocaine over 2 hours was
    able to produce and maintain a therapeutic plasma level of lidocaine that
    had an effect against the dynamic pressure-provoked pain and allodynia.
    However, 2-hour pain reduction may not be enough to make this treatment worthwhile, and the authors did not record whether pain relief continued after the cessation of therapy. Such an outcome would be ideal, as patients would generally be willing to have a weekly 2-hour infusion if it had a marked effect on long-term quality of life. It is unlikely that low-dose IV lidocaine had the required long-term effect on pain relief or quality of life since while the area of allodynia and its sensitivity was reduced, it was not abolished. Furthermore, placebo was just as effective as lidocaine for reducing ongoing pain.
    THE VZV RESEARCH
    FOUNDATION (VZVRF)
    WAS ESTABLISHED
    IN 1991 BY
    RICHARD PERKIN

    American Herpes Foundation Monitor
    Last edit by mommatrauma on Mar 22, '05
  6. 0
    In my many years working in ED at various hospitals including a couple teaching ones thats a new one on me. In fact I have been doing this so long I can remember we gave chest pain pts lidocaine about as often as we give them NTG sublingual now. I have given a couple times for pain but I now for the life of me cant recall the specific's.

    I did a quick net search and for one study after looking for about 5 mins where it was given to 16 pts for fibromyalgia. So you can take that one for what its worth. Looking further there another study re a 5% lidocaine patch for neuopathic pain. Heres the link for that one. http://www.asaabstracts.com/strands/...11&absnum=1372

    So I guess it makes sense since shingles effects nerves. Also if you are working at a teaching/university hospital and havent done that very long you are going to see some different treatments you never heard of before.

    rj






    Quote from Pill Hoarding Hussy
    i've only ever used lido gtts for VT. if this shingles thing is in fact a usage in practice, fill me in... cause it sounds weird.
    Last edit by rjflyn on Mar 22, '05
  7. 0
    Mammatrauma you must have been searching and typing the same time I was.
    rj
  8. 0
    Thanks for the info
  9. 0
    Quote from gabsev
    Have you ever given a Lido drip to treat pts c/o pain from Shingles? if so, what's the dose? Today I had a pt with shingles who was getting no relief after dilaudid, neurontin and morphine. The doc wanted to give a Lido drip ( I guess he's done it once in the past), but he couldn't remember the dose nor he could find any info from Pharmacy/ICU/PDR.
    Thanks
    I know this is a little late but I had fibromylgia and had Lido infusions at USC pain management clinic for 2 years by IV and it was the difference between me having a life or no life at all. I had it every 21 days and I was always ready for it.
    It truly stopped my pain, and it was 300"cc Lido in a drip for hours until my pulse, and resp changed and lips became tingly...Oh it worked wonderful....

    Vicki


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