Lignocaine Infusion Guidelines

 

Lignocaine Infusions

Lignocaine, also known as lidocaine or xylocaine, is a commonly used anaesthetic. Local anaesthetic agents may be used for patients with persistent pain when other therapeutic modalities have been ineffective. Infusions of lignocaine are used with or without opioid therapy for the management of persistent pain, namely neuropathic and acute forms of nociceptive pain. 

Local anaesthetics are sodium channel blocking agents that halt impulse conduction in the excitable neuronal tissues such as peripheral nerves and spinal roots. These drugs affect the central nervous system, having both central and sedative effects. They cause widespread vasodilation, thereby anaesthetizing the irritated nerve
endings & interrupting the reflex pain arc. The abnormal vasoconstriction associated with pain is neutralized by the partial blockade of the sympathetic nervous system by the local anaesthetic.

Lignocaine has a rapid onset and a moderate duration of action. 

 

Guidelines for Infusion and Observation

A lignocaine infusion should be administered through a dedicated line using an infusion pump.

Blood pressure, pulse rate, pulse oximetry, and pain and sedation score are monitered hourly for the first 4 hours. Thereafter, monitoring is every 2 hours for the remaining duration of the infusion. ECG rhythm is monitored every 4 hours.

Note: These infusion guidelines do not represent hospital policy and procedure guidelines, which should be constructed separately with specific reference to frequency of intravenous fluid line and bag changes, frequency of IV cannula changes, type of pump used to deliver infusion and prescription orders.

 

Side Effects

Common, early side effects of lignocaine infusion include:

  • Metallic taste
  • Tinnitus
  • Lightheadedness
  • Agitation
  • Drowsiness

Moderate side effects include:

  • Difficulty with ocular focusing
  • Nystagmus
  • Slurred speech
  • Dysarthria, numbness of the lips and tongue
  • A tingling, heavy sensation in the extremities

Late, severe side effects may include:

  • Hypotension or hypertension
  • Bradycardia or tachycardia
  • Seizure
  • Anaphylaxis
  • Unconsciousness

Rarely, patients may experience anxiety and/or psychosis.

Should the patient experience any of the above listed side effects, the infusion should be suspended and the pain specialist contacted.

 

References

  1. Kosharskyy B, Almonte W, Shaparin N, Pappagallo M, Smith H. (2013) Intravenous infusions in chronic pain management. Pain Physician. 16(3): 231-49.

 

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