Systemic lidocaine for pain management
When administered systemically via the intravenous route, lidocaine modulates pain transmission in the central nervous system; this is distinct to its use as a local anaesthetic, whereby it relieves pain by blocking conduction in sensory nerves. Intravenous lidocaine should only be used by practitioners experienced in its use and when there are appropriate resuscitation facilities because systemic toxicity is common and potentially lethal.
Intravenous lidocaine infusions are most commonly used to treat chronic neuropathic pain in adults; however, it is less effective than ketamine. Intravenous lidocaine is also used as an adjuvant to treat acute postoperative pain. There is limited evidence that it improves postoperative outcomes (eg acute postoperative pain, opioid consumption) or that it reduces the development of chronic postsurgical pain. Intravenous lidocaine is also used as an adjuvant to treat cancer pain.
Intravenous lidocaine should only be prescribed to children by specialists experienced in its paediatric use because there is limited evidence of its use in children with chronic pain.