lidocaine hydrochloride (3268 / lignocaine, Anesiva / ALGRX 3268)

Perioperative 24-Hour Lidocaine Infusion Does Not Prevent Chronic Postthoracotomy Pain: A Triple-Blinded Randomized Controlled Trial.

Zheng Jun J, Pan Danyang D, He Shilang S, Ruan Xiangcai X et al.

Managing chronic postsurgical pain is challenging. Evidence supporting the use of perioperative lidocaine to prevent it is inconsistent, potentially due to insufficient infusion duration. To determine the effect of extending lidocaine infusion to 24 hours for treating chronic postsurgical pain in patients undergoing video-assisted thoracoscopic surgery. Triple-blind, controlled randomized trial. A tertiary center in a university hospital. Seventy-one patients undergoing elective video-assisted thoracoscopic surgery were randomized 1:1 to receive either 2% lidocaine or placebo infusion at a speed of 4 mL/h started after anesthesia induction and continued for 24 hours. Primary outcomes were chronic postsurgical pain at 3 months defined as present pain score > 0 on an 11-point Numeric Rating Scale. Secondary outcomes included acute pain and opioid use during the first postsurgical 48 hours, and chronic postsurgical pain for up to 6 months. The incidences of chronic postsurgical pain at either 3 or 6 months did not differ significantly between the placebo and lidocaine groups (50% vs 50%, P = 1.0; 27% vs 32%, P = 0.63, respectively). There were no significant differences in acute pain scores or opioid consumption between the groups. Dizziness was more frequent during lidocaine infusion (47% vs 14% in the placebo group, P < 0.01). No serious adverse events were reported. The follow-up period was limited to 6 months and there was a small number of patients. A perioperative lidocaine infusion for 24 hours added to multimodal analgesia did not prevent chronic postthoracotomy pain.

Intravenous Lidocaine Does Not Provide Additional Pain Reduction Beyond Placebo in Probable Nociplastic Chronic Low Back Pain: A Randomized Controlled Equivalence Trial.

Pahari Subrata S, Hazra Sandipan S, Das Partha Pratim PP

To evaluate whether repeated intravenous lidocaine infusions provide clinically meaningful benefit beyond placebo for pain reduction in probable nociplastic chronic non-specific low back pain. In this prospective, randomized, double-blind, placebo-controlled equivalence trial, 84 adults with CNSLBP and probable nociplastic pain features were randomized equally to receive either intravenous lidocaine (1 mg/kg bolus followed by 4 mg/kg infusion weekly for 4 weeks) or placebo saline infusion. All participants received background multimodal pain management consisting of amitriptyline and aerobic exercise. The primary endpoint was the between-group difference in VAS pain intensity at 3 months. Therapeutic equivalence was assessed using a prespecified equivalence margin of ± 1.5 VAS units and the two one-sided tests (TOST) framework. Secondary outcomes included sleep quality (PSQI) and functional disability (QBPDS). At 3 months, the between-group difference in VAS was 0.24 (90% confidence interval -0.33 to 0.81), entirely within the predefined equivalence bounds, confirming therapeutic equivalence (TOST p < 0.001). Both groups improved significantly over time without a significant group × time interaction. Improvement in sleep quality was greater in the lidocaine group (mean difference in change score 1.81; 95% CI 0.49-3.14; p = 0.027). Functional improvement numerically favored lidocaine, although continuous disability outcomes were not significantly different. Adverse events were more common in the lidocaine group but were mild, transient, and self-limiting. Repeated intravenous lidocaine infusions did not provide additional analgesic benefit over saline infusions administered alongside multimodal pain management in patients with probable nociplastic chronic non-specific low back pain.

Intravenous Lidocaine Does Not Provide Additional Pain Reduction Beyond Placebo in Probable Nociplastic Chronic Low Back Pain: A Randomized Controlled Trial- An Infographic.

Pahari Subrata S, Hazra Sandipan S, Das Partha Pratim PP

Intranasal Lidocaine Spray for Trigeminal Autonomic Cephalgia, Simple and Effective Treatment Modality: A Case Series of Five Patients.

Malik Aanchal A, Punj Jyotsna J, Pandey Ravinder Kumar RK, Jain Dhruv D et al.

Sphenopalatine ganglion block (SPGB) is a potential treatment option for trigeminal autonomic cephalgia (TAC) performed fluoroscopically or endoscopically. We explored the role of noninvasive SPGB via intranasal application of lidocaine (INL) in hemicrania continua (HC) and probable TAC. In 4 patients of HC, INL spray decreased baseline acute attacks from Numeric Rating Scale (NRS-11) 8-10/10 to nil acute attacks and baseline continuous NRS-11 from 2-6/10 to 0-2/10 in 3 months. In patient of probable TAC, multiple acute attacks a day of NRS-11 10/10 decreased to NRS-11 1-2/10 in 3 months follow-up, with acute attacks of 1-2 in a day. Ten percent INL spray may be used as noninvasive treatment modality for HC and probable TAC, both for acute attacks and decreasing basal continuous pain.