Peixoto, R.D., & Hawley, P. (2015). Intravenous lidocaine for cancer pain without electrocardiographic monitoring: A retrospective review. Journal of Palliative Medicine, 18, 373–377.

To document the clinical benefits and side effects of intermittent intravenous lidocaine infusions for severe cancer-related pain

The records of patients who received at least one IV lidocaine infusion were reviewed. Patients were categorized as having a major, a minor, or no response. The protocol was infusion over one hour with no loading dose. The first dose was given at 5 mg/kg in a concentration of 1–4 mg/ml. Doses were increased to a maximum of 10 mg/kg in 2 mg/kg increments. Allergies to local anesthetics, liver failure, cardiac failure, heart block, uncontrolled seizures, or systolic blood pressure greater than 160 were considered contraindications to lidocaine infusion.

• N = 51  
• MEDIAN AGE = 53 years (range = 23–90 years)
• MALES: 56.9%, FEMALES: 43.1%
• KEY DISEASE CHARACTERISTICS: Multiple tumor types
• OTHER KEY SAMPLE CHARACTERISTICS: Overall, 78.8% of patients had neuropathic pain.

• SITE: Single site  
• SETTING TYPE: Outpatient  
• LOCATION: Canada

• PHASE OF CARE: Late effects and survivorship
• APPLICATIONS: Palliative care

Retrospective, descriptive study

Response was defined as either a decrease of three or more points on a 10-point scale, a patient report of “much better” pain relief, or movement from moderate to mild pain (considered a major response).

Overall, 49% of patients had a major response, 23.5% had a minor response, and 27.5% had no response. In addition, 43.1% had some adverse effect during at least one of the infusions, but only one patient's infusions were discontinued. The most common temporary side effects were drowsiness (30.7%), perioral numbness (13.4%), nausea (5.7%), and minor blood pressure fluctuations (3.8%). No patients had palpitations or more serious events. Responses were felt by the end of the infusion, and they often improved over the next few days and lasted from a few hours to more than four weeks.

The results of this study showed clinical benefits for pain reduction for the majority of patients with insufficient control taking strong opioids. There were few adverse effects using this protocol.

• Small sample (< 100)
• Risk of bias (no control group)
• Risk of bias (no blinding)
• Risk of bias (no random assignment) 

This study suggested that intravenous lidocaine infusions can be safely administered in multiple settings without electrocardiogram monitoring and was effective for pain reduction in the majority of patients for varying lengths of time. Lidocaine infusion is a promising option for appropriate patients who have refractory pain. If patients are screened for cardiac problems prior to infusion, are observed, and are able to report side effects during infusion, this treatment could be administered in a variety of settings under close nursing supervision.