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.

Suspected renal colic

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

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.

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.