Evaluation of the concurrent use of lidocaine and ketamine infusions as adjunctive analgesia in the intensive care unit

The purpose of this study was to determine the safety and effectiveness of ketamine and lidocaine infusions for the management of pain in surgical critically ill patients. This is a retrospective case series with a total of seven patients aged 18 years or older, had ICU stay at least 24 hours, and received concurrent use of systemic lidocaine and ketamine infusions as an adjunct therapy for pain management were enrolled between March 2014 to August 2015. The primary outcomes included the time measurement to achieve a 20% reduction in pain scores after the initiation of lidocaine and ketamine and the difference in opioid requirements pre and post concurrent pain therapies. Secondary outcomes include development of adverse events while on dual therapy. The median time to achieve a 20% pain score reduction was 2 hours. The median opioid requirements was reduced comparing prior to the ketamine and lidocaine infusions and 24 hours while on dual therapy (morphine dose equivalent 90.33 mg vs. 56 mg). Two neurological adverse events were noted. The results of this study suggest that low-dose lidocaine and ketamine infusions can be a safe and effective adjunctive treatment option for selected ICU patients with severe pain. However, future studies need to be conducted to determine the safety and effectiveness of concurrent use of lidocaine and ketamine infusions aside from surgical ICU patients.

PDF

___

Barr J, Fraser GL, Puntillo K, Ely EW, Gélinas C, Dasta JF, Davidson JE, Devlin JW, Kress JP, Joffe AM, Coursin DB, Herr DL, Tung A, Robinson BR, Fontaine DK, Ramsay MA, Riker RR, Sessler CN, Pun B, Skrobik Y, Jaeschke R. American College of Critical Care Medicine. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013; 41(1): 263-306. [CrossRef]
Barr J, Pandharipande PP. The pain, agitation, and delirium care bundle: synergistic benefits of implementing the 2013 Pain, Agitation, and Delirium Guidelines in an integrated and interdisciplinary fashion. Crit Care Med. 2013; 41: 99-115. [CrossRef]
Mo Y, Thomas MC, Antigua A, Ebied A, Karras GE Continuous lidocaine infusion as adjunctive analgesia in intensive care unit patients. J Clin Pharmacol. 2017; 57(7): 830-836. [CrossRef]
Kranke P, Jokinen J, Pace NL, Schnabel A, Hollmanm MW, Hahnenkamp K, Eberhart LHJ, Poepping DM, Weibel S. Continuous intravenous lidocaine infusion for postoperative pain and recovery. Cochrane Database Syst Rev. 2015; 16(7): CD009642. [CrossRef]
Herroeder S, Pecher S, Schönherr ME, Kaulitz G, Hahnenkamp K, Friess H, Böttiger BW, Bauer H, Dijkgraaf MG, Durieux ME, Hollmann MW. Systemic lidocaine shortens length of hospital stay after colorectal surgery: A double-blinded, randomized, placebo-controlled trial. Ann Surg. 2007; 246(2): 192-200. Erratum in: Ann Surg. 2009; 249(4): 701. [CrossRef]
Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, Carter T, Cassidy CL, Chittenden EH, Degenhardt E, Griffith S, Manworren R, McCarberg B, Montgomery R, Murphy J, Perkal MF, Suresh S, Sluka K, Strassels S, Thirlby R, Viscusi E, Walco GA, Warner L, Weisman SJ, Wu CL. Management of postoperative pain: A clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council. J Pain. 2016; 17(2): 131-157. [CrossRef]
Jouquelet-Lacoste J, La Colla L, Schilling D, Chelly JE. The use of intravenous or single dose of low-dose ketamine for postoperative analgesia: a review of the current literature. Pain Med. 2015; 16(2): 383-403. [CrossRef]
Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, Janecek E, Domecq C, Greenblatt DJ. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981; 30(2): 239-245.