Adjuvant use of intravenous lidocaine for procedural burn pain relief: a
randomized double-blind, placebo-controlled, cross-over trial.
Author(s): Wasiak J, Spinks A, Costello V, Ferraro F, Paul E, Konstantatos A, Cleland H.
Affiliation(s): Victorian Adult Burns Service and School of Public Health and Preventative
Medicine, Monash University, The Alfred Hospital, Commercial Rd, Melbourne,
Victoria, Australia. J.Wasiak@alfred.org.au
Publication date & source: 2011, Burns. , 37(6):951-7
BACKGROUND: Pain is a major issue for patients with severe burn. High dose
intravenous opioids form the mainstay of procedural burns pain management;
however it was suggested that intravenous lidocaine assists with minimising the
pain experience. This study aimed to evaluate whether intravenous lidocaine
improved analgesic efficacy and decreased opioid consumption during a burn wound
care procedure.
METHODS: A prospective double-blind randomized crossover study compared
intravenous lidocaine versus placebo alongside patient controlled analgesia (PCA)
in 45 patients with severe burn undergoing wound care procedures (i.e. dressing
change±debridement) on two consecutive days. Subjects were randomised to either
the intervention or control condition on the first dressing day, and received the
alternate condition on the second dressing day. During the intervention
condition, subjects received lidocaine of 1.5 mg/kg/body weight followed by two
boluses of 0.5 mg/kg at 5-min intervals followed by a continuous infusion. During
the control condition, 0.9% sodium chloride was administered at an equivalent
volume, dose and rate to that of lidocaine. Primary end points included pain
intensity as measured by verbal rating scale (VRS), time to rescue analgesia,
opioid requests and consumption and overall anxiety and level of satisfaction.
RESULTS: Changes in the VRS score was significantly lower for lidocaine
[difference (95% CI)=0.36 (0.17-0.55)] as compared to placebo. However, 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 the first and second dressing procedures.
CONCLUSIONS: In this study, the clinical benefit of intravenous lidocaine for
pain relief during burn wound dressing changes in terms of overall pain scores
and opioid consumption was unremarkable. Further investigations using different
lidocaine regimes for the management of procedural burn pain are warranted.
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