H. L. Warren2, P. Faris1, D. H. Bivins2, E. R. Lockhart2, R. Muthukattil2, D. Lollar1,2 1Virginia Tech Carilion School of Medicine,Roanoke, VIRGINIA, USA 2Carilion Clinic,Roanoke, VIRGINIA, USA
Introduction: Pain control in patients suffering traumatic injury can be challenging. Exposure to opioid pain medications can lead to prolonged dependence, therefore regimens which reduce the amount of opioid analgesia are needed. We have identified no data regarding the use of intravenous lidocaine (IVL) in trauma populations. We sought to explore the safety of IVL in these patients.
Methods: We performed a single- institution retrospective review of trauma patients receiving IVL from 6/30/16-6/30/17. We extracted data on demographics, pre-admission substance use, injury severity, in-hospital analgesic use, PT/OT participation rates and side- affect events. The lidocaine group was compared with a non-lidocaine control (C) group which was matched based on age, sex, race and ISS score. Patients with length of stay <24 hours were excluded from the control group.
Results:81 patients received IVL and were compared to 89 controls. Age, sex, race and ISS were no different. Significantly more patients receiving IVL had a history of narcotic and polysubstance use (p<0.01). Mortality was the same (p=1.0) Hospital length of stay was longer in the IVL group (7.5 vs 11.8, p=0.01). 38/81 patients received a bolus and all patients received a drip. The mean rate was 1.47mg/hr. Duration of therapy was 1-41 days however the mode was 3 days. 28 side effect events occurred in 23 of 81 IVL patients (28.4%). The most common side effect was delirium (14/28). The rate of side effects was higher in the elderly cohort (7/13, 53.8%) than in the adult cohort (16/68, 23.5%). There was no relationship between side effects and blood lidocaine levels. Side effects resolved with cessation of medication. Side effects occurred in 5 of 89 control patients (5.6%).
Conclusion:Side effects of IVL were common but resolved with cessation of IVL. No mortality was attributed to IVL. IVL may be a useful adjunct for patients requiring high narcotic use with careful monitoring. Use of IVL in elderly patients requires caution. These results should be clarified with prospective evaluation.
