Subcutaneous Lidocaine for Cancer-Related Pain

Hawley, Philippa; Fyles, Gillian; Jefferys, Stephen G.

doi:10.1089/jpm.2019.0621

Cited by 9 publications

(9 citation statements)

References 34 publications

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“…The degree of workup before commencement of treatment and extent of hemodynamic monitoring during drug administration are different from those where parenteral Lidocaine was given in the hospital setting. 5 , 11 , 17 , 20 , 22 Assessment of liver and renal function before Lidocaine administration was only explicitly recommended in one article. 19 Similarly, an ECG was performed only in one pediatric patient before Lidocaine infusion was commenced.…”

Section: Resultsmentioning

confidence: 99%

“…A recent randomized, double-blind, placebo controlled crossover trial investigating the efficacy of weekly SC Lidocaine 10 mg/kg administered over 5.5 hours in patients with cancer pain was terminated early as it failed to show better results than placebo. 5 The authors posited that their cohort of patients was perhaps ''too well'' and wondered if a titrated-to-effect regimen instead of a weight-based protocol could have produced different outcomes. Comparing results from two groups of investigators that used a similar design (retrospective chart review) to separately study ''challenge before continuous infusion'' 4 and ''immediate continuous infusion'' 35 in patients with refractory cancer pain yields further insight.…”

Section: Discussionmentioning

confidence: 99%

“… 7 , 35 , 36 It is anticipated to be safer and more feasible maintaining a SC line for long periods outside the hospital, especially within the home setting. 5 , 15 Moderate diversity is noted in drug administration schedules, indicating a lack of consensus. Given that all included articles had reported positive outcomes, it is unclear which regimen should be supported.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 While distress associated with cancer pain may be alleviated adhering to the World Health Organization cancer pain guidelines, 3 some patients continue to suffer persistent symptoms, from unrelieved pain or adverse effects of treatments prescribed. 1,[4][5][6][7][8] Their symptoms are described as intractable or refractory. 9,10 By that time, these pains are frequently unresponsive to escalating opioids.…”

Section: Introductionmentioning

confidence: 99%

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Parenteral Lidocaine for Complex Cancer Pain in the Home or Inpatient Hospice Setting: A Review and Synthesis of the Evidence

Chong¹,

Yeo²

2021

Journal of Palliative Medicine

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Background: Cancer pain can remain refractory despite escalating opioids and adjuvants. Systemic Lidocaine is an option, but current approaches are hospital centered. While advantageous in advanced cancer, evidence is lacking for parenteral Lidocaine use in community-based care. Objectives: Review evidence for parenteral lidocaine in complex cancer pain outside the hospital setting. Design: Systematic review of peer-reviewed articles of any study design, including reviews. Search in four databases used keyword variations of “cancer,” “pain,” “Lidocaine,” and “parenteral.” Search was extended through reference lists of full texts assessed. Abstracted data from articles screened and selected were synthesized narratively by a palliative care clinician in Singapore. Results: Eight hundred eighty-three articles identified were screened by title and abstract. Twenty-eight full texts were assessed. Seven articles fulfilled criteria for synthesis of findings. A total of 73 patients received parenteral Lidocaine for mixed pains, reported collectively in 1 retrospective chart review, 3 practice guidelines, 2 case series, and 1 case study. Intravenous or subcutaneous Lidocaine was commenced in hospital or hospice and continued at home. Dosages and administration schedules varied, involving slow bolus with continuous infusion or the latter alone, for up to 240 days. All produced positive outcomes, with no severe adverse events. Monitoring included routine vital signs and conscious levels; electrocardiogram, liver, and renal function tests were uncommon. Lidocaine levels were not consistently assessed. Conclusion: Parenteral Lidocaine can be effective and safe in the community setting. More empirical studies are needed to inform patient selection and treatment protocol, and to validate expected outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Parenteral Lidocaine for Complex Cancer Pain in the Home or Inpatient Hospice Setting: A Review and Synthesis of the Evidence

Chong¹,

Yeo²

2021

Journal of Palliative Medicine

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“…The addition of lidocaine for an emerging neuropathic component, with weakness of the legs, did not provide any benefit 12. Lidocaine has variably been reported to provide some benefits in patients with a neuropathic component 13…”

Section: Discussionmentioning

confidence: 99%

When the game is hard, more complex weapons are needed

Mercadante

Adile

Ferrera

et al. 2022

BMJ Support Palliat Care

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ObjectivesThe aim of this paper is to illustrate how to manage a very difficult pain condition.MethodsThis is a clinical note of a complex approach using multiple analgesic regimens to effectively afford challenging pain situations.ResultsA man underwent an opioid dose titration, followed by dose stabilisation for some months. Then he underwent two opioid substitutions, unsuccessfully. A spinal analgesia provided good analgesia for a prolonged period of time, necessitating variable interventions to counteract the evolving, challenging clinical situation.ConclusionsThe description of this case illustrates the need of a high level of experience and knowledge to elaborate complex strategies step by step every time the pain syndrome was worsening. Recommendations are unlikely in these extreme circumstances, and treatment should be based on continuous clinical counteraction to the evolving clinical conditions.

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