Download word version

Intravenous (IV) lignocaine
Summary of the evidence

The 2005 review found conflicting evidence about the effectiveness of
intravenous (IV) infusion of lignocaine for the treatment of non-cancer pain.
Some studies reported short term benefit (up to 3 weeks) in the treatment of
neuropathic pain; others suggested it is not as effective as ketamine infusion.
A consistent positive effect was reported in the treatment of fibromyalgia,
although the relevance of these studies is questionable.

Lignocaine can have serious side effects, particularly in patients with some
cardiac conditions. Central nervous system effects may be expected.

The 2011 evidence update found that overall there is conflicting evidence on
the short term effectiveness of lignocaine infusion for neuropathic pain. The
four new studies identified provided no additional evidence and, like the
evidence examined in 2005, report on short term intervention and relief. The
conclusion is therefore that the 2005 clinical recommendation should remain
in place.
Clinical practice recommendation
The general use of intravenous infusion of lignocaine is not
recommended for the treatment of neuropathic pain (B).
Good practice points

Some IPM advisory group members advocate the use of intravenous infusions
of lignocaine as an interim intervention for some cases where it is difficult to
control acute or chronic pain; however, others suggest intravenous
interventions are behaviourally reinforcing.

One member of the IPM advisory group has observed an additional adverse
effect associated with lignocaine infusion in his unit, namely
thrombocytopenia; he therefore advocates baseline measurement and
periodic monitoring of platelet levels if the procedure is performed.
ACC purchasing recommendation
Do not purchase intravenous infusion of lignocaine for the general treatment of
adults with persistent neuropathic pain.
What is IV infusion of lignocaine?
Lignocaine is a local anaesthetic drug which is quite rapidly cleared from the
body/bloodstream. Infusions allow administration over an extended time via
either an intravenous drip or pump under safe monitoring conditions. This
procedure is used for both diagnostic and treatment purposes.
How is IV infusion of lignocaine done?
The patient should be recumbent on a bed or trolley. The drug is administered via
a drip or infusion pump connected to an intravenous cannula. Various protocols
are used for duration, quantity, evaluating effects and minimising hazards.
Where is IV infusion of lignocaine done?
The procedure must be carried out in a location with electronic vital signs
monitoring, and full resuscitation facilities and personnel should be available.
Common examples include day case procedure rooms, operating theatre recovery
rooms and hospital wards.
Who does IV infusion of lignocaine?
Medical practitioners with knowledge and expertise in managing and interpreting
all the effects and possible hazards and complications should perform or
supervise this procedure. Examples include anaesthetists, some physicians and
surgeons; commonly, parts of the care are delegated to a registered nurse.
How safe is IV infusion of lignocaine?
Overdose of lignocaine can be fatal. Some medical conditions make this
possibility more likely, eg low cardiac output, poor left ventricular function and
heart block. Prior electrocardiograph (ECG) and/or ECG monitor trace can detect
the latter. This outcome was not seen in the reports identified for this review, but
it cannot be underestimated that care is required to avoid this outcome.
Expected central nervous system side effects (endpoints for determining dose
size in some protocols) are paraesthesiae, perioral numbness, garbled
speech/dysarthria and changes in hearing.