We use intravenous lidocaine perioperatively pretty often and the results are mixed but typically successful. We have specific programming surrounding its use and we're all quite familiar with the protocols. With that said, I've probably seen close to fifty patients with IV lidocaine infusions, and every single one of them was a GI / abdominal surgery patient. We implemented the use of IV lidocaine (in conjunction with ketamine) to reduce opiate requirements in this population because of the heightened risk of complications from decreased bowel motility that come with post op immobility and opiate use. This care bundle is apparently having a measurable positive effect on early recovery after gi surgery in our facilities.
Lidocaine has a very VERY narrow therapeutic index. Serial lidocaine levels MUST be drawn to assess for toxicity. And as we all know, tox labs take forevahhhh to result. Its also specified in our protocol that if the patient's pain is not adequately controlled with the ketamine/lidocaine infusion, and they are requiring more opiates (the opiate requirements are patient specific), the lidocaine must be discontinued and the plan of care can be reverted to a more common pain control regimen. The reason for this is that concurrent opiate use can obscure the early symptoms of lidocaine toxicity which are often very patient subjective (blurred vision, metallic taste, peripheral neuropathy, etc). These patients are also receiving the benefit of sedation for some time post-operatively, which is ultimately aiding pain control by lack of awareness. Long story short, we're giving this to bridge the gi-surg patients from the OR until their bowels start showing signs of movement and then converting them to lower dose opiates if necessary.
with all that said
none of that **** makes any sense for use in an ER.
More (interesting and totally readable) info on ERAS here