Low-Dose Lidocaine Infusion for Acute Pain Management Pilot Study

The management of acute pain remains challenging for the physicians, with many patients suffering from inadequate pain control following surgery. Evidence has shown that 90% of patients in the intensive care unit usually treated with opioids for pain. Poorly controlled pain and opioid-related adverse events have several negative consequences for critically ill patients during the postoperative period, including delay in functional recovery and hospital discharge, increased length of stay, development of chronic postsurgical pain, reduced patient satisfaction, and increased total healthcare cost. The reported incidence of postoperative Ileus varies with the procedure, ranging from 14.9% for large-bowel resection and 19.2% for small-bowel resection). Although many analgesic therapies are available, the high incidence of postoperative pain among patients indicates that there are still significant treatment challenges. Recently, there has been much interest in using low-dose lidocaine infusion for acute pain management in the operating room or/and PACU. Lidocaine is a drug with multiple effects, including anti-arrhythmic, local, topical, and injectable anesthetics. Lidocaine is also used for uncontrolled and chronic pain. However, this is an off-label use. Additionally, I.V. lidocaine is a potent anti-inflammatory, anti-hyperalgesic, and gastrointestinal pro-peristaltic drug. There is a lack of data on low dose lidocaine infusion for acute postoperative pain management in surgical critical care patients.

Inclusion criteria

• Males or females age > 18 years admitted to surgical ICU.
• Severe acute pain with pain scale > 7, following open exploratory laparotomy for bowel, gall bladder, and pancreatic surgeries.
• Women of childbearing age must have a negative urine/serum pregnancy test.

Exclusion criteria

• Regional anesthesia during surgery
• Heart failure with ejection fraction < 20%.
• Allergy to amide local anesthetics
• Neuraxial anesthesia during surgery
• Post-liver transplant patients
• Hemodynamically unstable patients on two or more vasopressors
• Child-Pugh Class C or MELD >20
• Any investigational drug use within 30 days before enrollment
• Pregnant or lactating females
• Patients with chronic opioid-dependence
• Intubated and mechanically ventilated patients on intensive care unit analgo-sedation
• Subjects who do not agree to participate or may be non-compliant with study schedules or procedures.