Intravenous Lidocaine for XXXX without Electrocardiographic Monitoring: A Retrospective Review.

@entity1 @entity1183 @entity390 @entity5 @entity158
BACKGROUND: Intravenous lidocaine infusion has been clearly demonstrated as effective for @entity158 in randomized controlled trials, but the belief that cardiac monitoring is required for safe administration is a barrier to access in the palliative care setting. There are also multiple infusion protocols reported in the literature. We have been administering lidocaine infusions for severe @entity5 @entity158 at the BC Cancer Agency (BCCA) since 2003, without electrocardiographic (ECG) monitoring. Our simple protocol is for 5   mg/kg to be infused over 1 hour, with the option for subsequent doses to be increased if necessary, up to a maximum of 10   mg/kg. Our aim with this study is to share 11 years of our experience with this protocol. METHODS: This is a retrospective case series. Records of @entity1 who received at least one lidocaine infusion for @entity158 between 2003 and 2013 at the BCCA were reviewed. The primary end points were the documentation of clinical benefit and adverse effects. RESULTS: A total of 122 lidocaine infusions were administered in 51 individual @entity1 . Twenty-five (49%) had a major response, 12 (23.5%) had a minor response, and 14 (27.5%) were considered nonresponders. Twenty-two (43.1%) @entity1 were noted to have some adverse effect during at least one of the infusions, but only 1 (1.9%) @entity1 had the infusion permanently discontinued. The most common side effects were drowsiness (30.7%), perioral @entity1183 (13.4%), @entity390 (5.7%), and minor fluctuations of blood pressure (3.8%). CONCLUSIONS: This case series demonstrates that our protocol of infusional lidocaine can be beneficial to @entity1 with @entity5 with severe @entity158 , and can safely be administered with close observation and vital sign monitoring, without ECG monitoring. Lidocaine infusion is a useful option to consider when other @entity158 treatments have not been successful. Although only approximately half of @entity1 will respond well, there is little harm to be expected from a trial of lidocaine infusion and responders can be repeatedly treated. This treatment could be delivered in palliative care units, hospices, or even @entity1 ' homes, providing suitable nursing supervision can be provided.
