Topical lidocaine as an adjuvant for pain management

When administered topically, lidocaine can modulate pain in the peripheral nervous system if used in low concentrations (eg 5%). This is distinct to its use as a local anaesthetic because anaesthesia does not occur at low concentrations.

Lidocaine 5% patches are a suitable first-line analgesic for localised neuropathic pain (eg postherpetic neuralgia) and have comparable efficacy to pregabalin. They are particularly useful for frail or elderly patients, or patients taking multiple medications, because they have few systemic adverse effects and drug interactions. See The role of adjuvants for chronic noncancer pain for dose advice.

There is limited high-quality evidence to support the use of lidocaine 5% patches for children younger than 18 years. In children aged 6 to 18 years, small case series suggest efficacy and low toxicity if used at appropriate paediatric doses. In children, lidocaine 5% patches should only be prescribed by specialists; seek paediatric specialist advice for the management of localised neuropathic pain.