Intravenous lidocaine for the treatment of background or procedural burn pain.
Author(s): Wasiak J(1), Mahar PD, McGuinness SK, Spinks A, Danilla S, Cleland H, Tan HB.
Affiliation(s): Author information:
(1)Department of Orthopaedic Surgery, The Epworth Hospital, 89 Bridge Rd,
Richmond, Australia, 3121.
Publication date & source: 2014, Cochrane Database Syst Rev. , 10:CD005622
BACKGROUND: This is an update of the review on "Lidocaine for pain relief in burn
injured patients" first published in Issue 3, 2007, and first updated in 2012.
Pain is a major issue for people with many different types of wounds, in
particular those people with burn injuries. Prompt, aggressive use of opioid
analgesics such as morphine has been suggested as critical to avert the cycle of
pain and anxiety, but adverse effects are encountered. It has been proposed that
newer agents such as lidocaine could be effective in reducing pain and
alleviating the escalating opioid dosage requirements in people with burn injury.
OBJECTIVES: To assess the safety and effectiveness of intravenous lidocaine as a
means of pain relief versus no therapy, placebo, other drugs, or a combination of
these therapies in people with burn injury.
SEARCH METHODS: For this third update, we searched the Cochrane Central Register
of Controlled Trials (Issue 11, 2013), and Ovid MEDLINE, MEDLINE in Process and
Ovid EMBASE (up to December 2013).
SELECTION CRITERIA: We included randomised controlled trials (RCTs) and
controlled clinical trials (CCTs), published and unpublished, which assessed the
efficacy of intravenous lidocaine in varying doses as a single-agent therapy with
no therapy, placebo, other analgesics (such as opioids), lidocaine plus another
drug, or a combination of these therapies as a means of pain relief in people
with burn injury.
DATA COLLECTION AND ANALYSIS: Two review authors independently abstracted data
and assessed the risk of bias of the studies identified.
MAIN RESULTS: In this 2014 update, we found no new studies. The one small
randomised double-blind placebo-controlled cross-over trial found in 2012, which
included only 45 participants and compared intravenous lidocaine against placebo
as a means of pain relief in people with burns still remains central to this
review. We assessed this study as being at a high risk of bias due to its small
size (fewer than 50 participants per treatment arm). Subjective pain ratings, as
measured by the verbal rating scale, increased during procedures for both
treatment arms; however, the increase was less in the lidocaine treatment group.
There were no significant clinical or statistical differences regarding the
effects of lidocaine and placebo on opioid requests and consumption, anxiety or
level of satisfaction during a wound care procedure, but the small included study
provided insufficient data to draw any conclusions.
AUTHORS' CONCLUSIONS: As current clinical evidence is based on only one RCT as
well as case series and reports, intravenous lidocaine must be considered a
pharmacological agent under investigation in burns care, the effectiveness of
which is yet to be determined with further well-designed and conducted clinical
trials.
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