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Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie 7/2019

01-07-2019 | Neuropathic Pain | Report of Original Investigations

Intravenous lidocaine in the management of chronic peripheral neuropathic pain: a randomized-controlled trial

Authors: Dwight E. Moulin, MD, Patricia K. Morley-Forster, MD, Zameer Pirani, MD, Cathy Rohfritsch, RN, Larry Stitt, MSc

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 7/2019

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Abstract

Purpose

Neuropathic pain, resulting from injury to the peripheral or central nervous system, is due to upregulation of aberrant sodium channels with neuronal hyperexcitability. Lidocaine blocks these channels and several studies show that intravenous (IV) lidocaine infusion provides significant relief in patients with chronic peripheral neuropathic pain in the short term (for up to six hours). Our objective was to determine if IV lidocaine provides significant pain relief and overall improvement in quality of life in the longer term (for up to four weeks).

Methods

This single site randomized double-blind, crossover trial compared IV lidocaine infusion (5 mg·kg−1) with active placebo infusion containing diphenhydramine (50 mg) in patients with chronic neuropathic pain of peripheral nerve origin of at least six months duration. The primary outcome was average pain intensity reduction from IV lidocaine relative to placebo at four weeks post-infusion. Secondary outcome measures included parameters of physical function, mood, and overall quality of life.

Results

We enrolled 34 subjects in this trial—mostly with painful diabetic neuropathy and post-herpetic neuralgia. There were no significant differences between IV lidocaine and placebo infusions at any time point involving any of the outcome measures. Mean (standard deviation) pain intensity at week 4 for the placebo and lidocaine groups were not different [6.58 (1.97) vs 6.78 (1.56), respectively; between-group difference, 0.17; 95% confidence interval, − 0.50 to 0.84].

Conclusion

We found no significant long-term analgesic or quality of life benefit from IV lidocaine relative to control infusion for chronic peripheral neuropathic pain.

Trial registration

clinicaltrials.gov (NCT01669967); registered 22 June, 2012.
Appendix
Available only for authorised users
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Metadata
Title
Intravenous lidocaine in the management of chronic peripheral neuropathic pain: a randomized-controlled trial
Authors
Dwight E. Moulin, MD
Patricia K. Morley-Forster, MD
Zameer Pirani, MD
Cathy Rohfritsch, RN
Larry Stitt, MSc
Publication date
01-07-2019
Publisher
Springer International Publishing
Published in
Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 7/2019
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI
https://doi.org/10.1007/s12630-019-01395-8

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