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4.3.5 Membrane stabilisers
Perioperative IV lignocaine (lidocaine) infusion was opioid‐sparing and significantly reduced
pain scores, nausea, vomiting and duration of ileus up to 72 hours after abdominal surgery and
also reduced length of hospital stay (Marret et al, 2008 Level I). The addition of lignocaine to
morphine PCA conferred no benefit in terms of pain relief or side effects (Cepeda et al, 1996
Level II).
Intraoperative epidural lignocaine infusion resulted in significantly lower use of patient‐
controlled epidural analgesia (PCEA) and earlier return of bowel function in the 72 hours
following colectomy compared with IV lignocaine; however the latter was still significantly
better than placebo (Kuo et al, 2006 Level II). Mexiletine improved pain relief and reduced
analgesic requirements after breast surgery (Fassoulaki et al, 2002 Level II).
IV lignocaine has been used to provide analgesia for burns procedures, however a Cochrane
review reported that more trials were required to determine its efficacy (Wasiak & Cleland, 2007
Level I).
The efficacy of lignocaine in the treatment of acute migraine is unclear. Analgesia provided by
IV lignocaine was similar to dihydroergotamine, but not as effective as chlorpromazine (Bell et
al, 1990 Level II) and in one trial no better than placebo (Reutens et al, 1991 Level II). Results for IN
lignocaine are conflicting (Maizels et al, 1996 Level II; Blanda et al, 2001 Level II).
Under experimental conditions, IV lignocaine reduced neuropathic pain in spinal cord injury
(Finnerup et al, 2005 Level II) and reduced spontaneous pain and brush allodynia in central pain
(Attal et al, 2000 Level II). Also after spinal cord injury, lignocaine reduced pain in only one of ten CHAPTER 4
patients (Kvarnstrom et al, 2004 Level II); mexiletine did not reduce dysesthetic pain (Chiou‐Tan et
al, 1996 Level II).
Both lignocaine and mexiletine were more effective than placebo in treating chronic
neuropathic pain, however there was no difference in efficacy or adverse effects when
compared with carbamazepine, amantadine, or morphine (Challapalli et al, 2005 Level I).There
was strong evidence of benefit for use of membrane stabilisers in pain due to peripheral nerve
trauma (Kalso et al, 1998 Level I). Stump pain but not phantom pain was reduced by IV
lignocaine (Wu et al, 2002 Level II).
Currently, the use of membrane stabilisers for acute neuropathic pain can only be based on
extrapolation of the above data.
Key messages
1. Both lignocaine (lidocaine) and mexiletine are effective in the treatment of chronic
neuropathic pain (S); there is no difference in efficacy or adverse effects compared with
carbamazepine, amantadine, or morphine (N) (Level I [Cochrane Review]).
2. Perioperative intravenous lignocaine reduces pain and opioid requirements following
abdominal surgery (S) as well as nausea, vomiting, duration of ileus and length of hospital
stay (N) (Level I).
The following tick boxes represent conclusions based on clinical experience and expert
opinion.
Based on the experience in chronic neuropathic pain states, it would seem reasonable to
use membrane stabilisers in the management of acute neuropathic pain (U).
Lignocaine (intravenous or subcutaneous) may be a useful agent to treat acute neuropathic
pain (U).
Acute pain management: scientific evidence 91
