This systematic review evaluates the safety and efficacy of intravenous (IV) lidocaine for the treatment of acute pain in adult patients. The PubMed database was searched for randomized controlled trials, retrospective cohort studies, case series, and case reports evaluating the use of IV lidocaine for the treatment of acute pain in adult patients, published between January 1970 and January 2018. The primary outcome was pain reduction via the Visual Analog Scale, Verbal Rating Scale, or Numeric Rating Scale among patients treated with IV lidocaine and placebo or active controls. Safety outcomes included both nonserious and serious adverse events. A total of 347 titles and abstracts were screened, and after full‐text review, 13 studies met the inclusion criteria involving 512 patients. The four active controls studied were IV morphine, IV ketorolac, IV dihydroergotamine (DHE), and IV chlorpromazine (CPZ). The dosing of IV lidocaine varied among studies between a weight‐based dose of a 1‐ to 2‐mg/kg bolus, a fixed‐bolus dose of 50–100 mg, and a 1‐mg/kg/hour continuous infusion. Monitoring of serum lidocaine concentrations was not done routinely. Intravenous lidocaine had superior efficacy to morphine for renal colic and critical limb ischemia, superior efficacy to DHE for acute migraine, and equivalent efficacy to ketorolac for acute radicular lower back pain. However, lidocaine was less effective than CPZ for the treatment of acute migraine. The most common adverse event reported among all studies were neurologic effects such as altered mental status and slurred speech. Due to the inconsistency in dosing, length of administration, and lack of serum monitoring, the absolute safety of IV lidocaine for acute pain is unknown. Larger, prospective studies are needed before the routine use of IV lidocaine can be recommended for all types of acute pain.

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A majority of patients with severe sepsis and septic shock are first evaluated in the emergency department (ED). Methods such as screening tools have proven advantageous in earlier identification, allowing for timely initiation of treatment. Delay in symptom presentation and ED overcrowding contribute to deferment of sepsis bundle components and admission. To examine the impact of time from ED arrival to inpatient admission on mortality and length of stay (LOS) in patients with severe sepsis or septic shock. A retrospective analysis of adult patients with severe sepsis or septic shock was completed for those presenting between January 2013 and December 2014. Patients were dichotomized on the basis of the length of time from completed triage in the ED to intensive care unit (ICU) admission (at less than 6 hr and at 6 hr or more). Of the 294 patients screened, 172 patients (58.5%) met inclusion criteria (n = 70 cases at less than 6 hr; n = 102 at 6 hr or more). Mean wait time from ED arrival to ICU admission was 470.7 ± 333.9 min (range = 84-2,390 min). Groups were similar in baseline, disease severity, and bundle characteristics. There were no differences in the less than 6-hr group compared with the 6-hr-or-more group in rates of 30-day mortality (37.1% vs. 32.4%; p = 0.52), as well as in-hospital (27.1% vs. 23.5%; p = 0.59) or 90-day mortality (42.9% vs. 34.3%; p = 0.26). There were also no differences in hospital or ICU LOS. Timing of transfer from the ED to the ICU was not found to impact mortality or LOS. These results suggest that the ED can provide similar sepsis care to that in the ICU when transfer is delayed in patients with sepsis.

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