Starting Intravenous (IV) Lidocaine for Pain in the Hospital

Lidocaine is a medicine most often used to numb the skin and treat certain heart conditions. It can be used to treat many pain conditions by slowing the spread of pain signals or calming damaged nerves. 

Benefits 

The infusion may help to: 

• lower your pain to a more manageable level

• decrease the number of pain medicines you take

• increase your ability to do activities 

Tests Needed Before Using Lidocaine

Lidocaine is a safe treatment for most people. To make sure it is a safe option for you, an electrocardiogram (ECG) is done to check your heart rhythm. 

Your doctor may also order a lidocaine trial. Any abnormal results will be reviewed with you before deciding if the trial should be done.

If you are pregnant, breastfeeding, or thinking about getting pregnant, please tell the team. Lidocaine infusions are not safe if you are pregnant.

Patients may eat and drink normally on the day of infusion. All medicines can be taken as prescribed.

What to Expect During the Trial

Your nurse will start an IV in your arm. The lidocaine will be given over 1 hour (adults) or 1½ to 2 hours (pediatrics). Let your nurse know of any side effects, no matter how minor they may seem. Your nurse may slow or stop the infusion based on side effects. You will be monitored during the infusion and for 30 minutes after. 

We will try to keep you as comfortable as possible. Feel free to bring something to read or a tablet/iPad with headphones.  

Side Effects

As with any medicine, there is always a chance that you may have side effects. These tend to be mild and go away once the infusion is slowed or stopped. However, some patients may have side effects that last for many hours. Most side effects will be gone by the time you leave. Side effects might include:

• drowsiness

• lightheadedness or feeling dizzy

• tongue heaviness or slurred speech

• nausea (this can be reduced by eating before the infusion)

• numbness/tingling around the mouth

• headache

• blurry or double vision

• ringing in your ears or tunnel hearing

• metallic taste in your mouth

Serious side effects are rare but can happen. More serious problems could include:

• low or high blood pressure

• a slow or fast heart rate

• abnormal heartbeats

• fainting

• seizures

• an allergic reaction which, in very rare cases, can lead to death

Recovery

Recovery is about 15-30 minutes. The nurse will take vital signs before you leave. Patients often feel a bit drowsy and confused after, therefore it is not safe to drive. 

If you have any side effects, the RN will turn off the infusion. A sample of blood may be taken if symptoms continue. The mild side effects will occur first and are an early warning of a toxic amount of lidocaine. It is very important to pay attention to the side effects listed.

Most of the time, the side effects will be gone within 30 minutes to an hour after stopping the infusion, but they could last longer. If you have side effects, talk to your provider to figure out when or if you should restart the infusion.

How You Can Help

Use a pain scale to describe your pain. On a scale of 0 to 10, with 0 being no pain, and 10 being the worst pain you can imagine, how much pain do you have right now?

Talk with your doctors and nurses about any concerns or fears you may have about pain and its treatment.

Tell us what medicines you are taking for other health problems. We need to know because mixing some drugs with pain medicines can cause problems.

If you are getting a continuous infusion, know what side effects might happen and report them to your nurse and doctor. When at home, be prepared to have your lidocaine level drawn if needed.

After Treatment

If you are in the hospital, the team will follow up with you in the next 24 hours. The team will decide if the test dose was a success and whether more treatment is needed. They will decide, with your input, if a continuous infusion will be most helpful or outpatient treatment with intermittent infusions. If you are getting a continuous infusion, it can take about 2-3 days to find the right dose. The total treatment time will depend on how well it works to control your pain. Most patients will receive treatments for at least a few months.