Using IV Lidocaine for Pain

Lidocaine is a medicine most often used to numb the skin and treat certain heart conditions. It is also used to treat many pain conditions. It helps to stop the spread of pain signals. It also helps to calm damaged nerves or nerves that are misfiring, which reduces pain. 

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. Blood is drawn to check on the health of your kidneys and liver. 

Based on the test results, your doctor will order a lidocaine trial. Any concerning 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.  

Next Steps

Once the doctor signs the orders, the Prior Authorization team works with your insurance company to check coverage. This process may take 2-3 weeks. If approved, the infusion center staff will call you to set up your trial. Once scheduled, you will need to set up a follow-up visit with the provider who ordered your infusion. This visit should be 1-2 weeks after your trial.

What to Expect During the Trial

Your first infusion will be at the hospital or Pain Clinic infusion center. Be sure to arrive 15 minutes before your scheduled visit time. While we try hard, we can’t always fit in patients who are late. If you need to cancel your visit, please call us as soon as possible.

Lidocaine will not be given if your blood pressure is too high or too low or if your heart rate is too fast or too slow.

Your appointment will take about 2 hours. An IV will be started in your arm. Lidocaine is given over 1 hour. Let your nurse know of any side effects, no matter how minor they may seem. Your infusion may be slowed or stopped 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.  

After the Lidocaine Trial

Driver: You must have someone drive you home after your first infusion visit and any time your dose is changed. If you do not have someone to drive you home, your infusion will be rescheduled. It is best to have a driver for all repeat infusions. 

Pain log: You will be given a pain log to fill out each day. This helps to track how well the lidocaine worked, how long it lasted, and if you had side effects. The treatment works over many days. It may take time to learn how effective it can be for you. Lidocaine does not work for everyone.

Bring the pain log to your follow-up visit. You and your provider will discuss if you should keep getting the infusions. This decision must be discussed in person; it cannot be done over the phone or through MyChart. 

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

• itching

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

Common Questions

Does insurance pay for this? 

Most insurance companies do cover the cost, but not all. That is why insurance company approval is required before scheduling your infusion. 

How long do the benefits last? 

The response to lidocaine varies from person to person. Some feel relief for a few short hours, or for weeks or months, and some have no relief at all.

Does lidocaine become less effective the longer I am on it? That is a possibility. Make an appointment with your provider if this happens. 

What are the long-term effects? 

There have not been any long-term studies. You will need to be screened every 6-12 months to make sure it is safe to continue the infusions. It is very important for you to tell us about any new health changes, such as:

• liver or kidney problems, 

• heart problems (irregular heartbeats or an abnormal ECG),

• seizure disorders, and/or

• a reaction to local anesthetic.

Can my infusion be done closer to home? 

All lidocaine trials ordered at UW must be done at a UW Health facility. If you wish to have this done closer to home, it must be at an infusion center with a doctor who understands how to order and supervise the infusions. We may be able to help your local doctor with this.

If you have any questions or concerns, please call your clinic. To review a video on this topic, go to https://www.uwhealth.org/lidocaine.