Intravenous lidocaine: An outdated or underutilized treatment for pain?

Background: Conventional analgesic treatment involves the use of oral and transdermal formulations of drugs that require repetitive administration for sustained pain relief to be achieved. Along with the potential of analgesia, the risk of ongoing side effects consequent on the use of these analgesics also exists and this may have a detrimental effect on the patient's quality of life. In contrast, an intriguing body of evidence suggests that short-term administration of intravenous lidocaine may produce pain relief that far exceeds both the duration of infusion and the half-life of the drug. When pain relief is produced, concomitant analgesic medication can be reduced, side effects from pain relieving medication minimized with a potential for very real improvement in the quality of life of the patient. Objective: To ascertain whether literature evidence supports the use of intravenous lidocaine in clinical practice. Design: A review of the currently available published evidence. Results: A reasonable body of evidence, along with extensive clinical experience, suggests that intravenous lidocaine can have a useful pain-relieving effect and is worth consideration in palliative care patients. Conclusion: While this form of therapy is not commonplace in the terminally ill patient, it could be argued that its use has much merit in that field and should be considered.