Intravenous lidocaine in cancer-related neuropathic pain: case series

Abstract

Introduction: Administering systemic lidocaine has been shown to deliver effective analgesia for both cancer-related and non-cancer pain. Adverse effects and toxicity are rare with controlled administration. Objective: To report the results obtained after the indication to manage with IV lidocaine infusion to control neuropathic pain flares in 9 cancer patients. Methodology: Observational, descriptive, case series-type study. A search was conducted in the files of the Pain and Palliative Care Service of the National Cancer Institute - Instituto Nacional de Cancerología - in Bogotá. Patients over 18 years old diagnosed with cancer, who experienced high intensity neuropathic pain and with the cognitive ability to rate their pain in a numerical analogue scale (NAS), without any absolute contraindications for the use of IV lidocaine were included; patients were assessed between September 27 and November 21, 2019. Results: 9 patients experiencing a pain flare-up which was characterized as neuropathic were registered, of which 89 % had some improvement following the administration of an initial lidocaine bolus. After one hour, 60 % reported over 40% improvement in the initial NAS. After 24 hours all patients had experienced some improvement, with a reduction of 46% in the pain scale as compared to the baseline. Conclusions: In this series of cases, the intravenous infusion of lidocaine as an option for the management of neuropathic pain flares seems to reduce pain intensity following the initial bolus administration.