• Jay Thomas, Robert Kronenberg, Michael Craig Cox, Gilbert C Naco, Mark Wallace, and Charles F von Gunten.
• San Diego Hospice and Palliative Care, San Diego, California 92103, USA. jthomas@sdhospice.org
• J Palliat Med. 2004 Oct 1;7(5):660-7.

BackgroundParenteral lidocaine has been reported to relieve neuropathic pain and/or pain refractory to opioid therapy.MethodA retrospective chart review of 768 consecutive patients acutely admitted to a hospice inpatient unit was performed to assess the efficacy and tolerability of parenteral lidocaine for pain relief.ResultsEighty-two patients (approximately 11%) received parenteral lidocaine. Typically, a patient received a parenteral bolus and pain relief was evaluated 30 minutes later. If there was an effect, a continuous infusion was started. Sixty-one patients receiving lidocaine were evaluable for pain relief response. Fifty patients (82% of evaluable patients) reported a major response of their pain to lidocaine. Five patients (8% of evaluable patients) reported a partial response. Six (10% of evaluable patients) reported no benefit.DiscussionEvaluable patients in an opioid refractory class had a 91% major response rate to lidocaine. Overall, lidocaine was well tolerated. Approximately 30% of evaluable patients reported some adverse event; the most common being lethargy. However, the effect was not clearly related to lidocaine.ConclusionParenteral lidocaine appears to be rapidly effective for opioid refractory pain and is well tolerated. A randomized controlled trial is needed to confirm these impressive but preliminary uncontrolled results.

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