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Section IconIntravenous Lidocaine for Renal Colic
Overview
Intravenous lidocaine has been extensively studied and found to be effective and safe in acute postoperative pain and chronic severe neuropathic pain. It has been investigated as a nonopioid alternative in the ED management of pain associated with renal colic. In one ED-based RCT, it was found to be more effective than weight-based morphine.
Indications
Suspected renal colic
Contraindications
History of seizures, including isolated single seizure and alcohol withdrawal seizure
History of severe cardiac disease: recent stent placement, severe structural/valvular heart disease, or significant arrhythmia
Pregnancy
Equipment & Dosing
1.5 mg/kg with a maximum dose of 200 mg over 10 minutes via pump
200 mg/100 cc 0.9% normal saline
Cardiopulmonary monitoring is required during administration and for 30 minutes after.
Procedure & Administration
Multimodal administration is recommended (administer together)
  • Intravenous cardiac lidocaine 1.5 mg/kg (maximum 200 mg)
  • Ketorolac 15 mg IV x1
  • 1 L 0.9% normal saline
  • Acetaminophen 1,000 mg PO or IV
For ease of ordering and quick administration, place an order in the department’s EMR system. The medication should be readily available within the department’s Pyxis or OmniCall. Delaying administration because of waiting for pharmacy to mix medication presents a significant barrier for alternative use. Alternative medications must be as easy to administer as opioid medications.
References
  1. Ferrini R, Paice JA. How to initiate and monitor infusional lidocaine for severe and/or neuropathic pain. J Support Oncol. 2004 Jan–Feb;2(1):90–4. [PubMed]
  2. Vigneault L, Turgeon A, Côté D, et al. Perioperative intravenous lidocaine infusion for postoperative pain control: a meta-analysis of randomized controlled trials. Can J Anaesth. 2011;58(1):22-37. [PubMed]
  3. Farag E, Ghobrial M, Sessler D, et al. Effect of perioperative intravenous lidocaine administration on pain, opioid consumption, and quality of life after complex spine surgery. Anesthesiology. 2013;119(4):932-940. [PubMed]
  4. Soleimanpour H, Hassanzadeh K, Vaezi H, Golzari S, Esfanjani R, Soleimanpour M. Effectiveness of intravenous lidocaine versus intravenous morphine for patients with renal colic in the emergency department. BMC Urol. 2012;12:13. [PubMed]
  5. Macintyre P, Rowbotham D, Walker S, eds. Clinical Pain Management Second Edition: Acute Pain. 2nd ed. CRC Press; 2008.
  6. Eipe N, Gupta S, Penning J. Intravenous lidocaine for acute pain: an evidence-based clinical update. B. 2016;16(9):292-298. doi:10.1093/bjaed/mkw008
  7. Buck M. Use of lidocaine for analgesia in children and adolescents [PDF]. University of Virginal Children’s Hospital. Download PDF. Published December 2013. Accessed February 10, 2018.
  8. Ferreira S. Prostaglandins, pain, and inflammation. Agents Actions Suppl. 1986;19:91-98. [PubMed]
  9. LaPietra A, Motov S, Rosenberg M. Alternatives to Opioids for Acute Pain Management in the Emergency Department: Part I. Emergency Medicine Reports. Learn More. Published October 1, 2016. Accessed February 10, 2018.
  10. Neal J, Mulroy M, Weinberg G, American S. American Society of Regional Anesthesia and Pain Medicine checklist for managing local anesthetic systemic toxicity: 2012 version. Reg Anesth Pain Med. 2012;37(1):16-18. [PubMed]
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