Lidocaine Infusion as An Adjuvant for Acute Pain Using a Multimodal Approach to Pain: A Case Series

Case Diagnosis: Acute hip pain related to abdominal trauma and skin grafting; Acute lower back pain related to paraspinal abscesses

Case Description OR Program Description (A tertiary care hospital): A 17-year-old female was admitted into the Pediatric Intensive Care Unit after a motor vehicle crash. She had multiple procedures, including exploratory laparotomy and skin grafting over the hip which caused a constant ache and throbbing pain. She was NPO and was treated with hydromorphone PCA. A 54-year-old female with a history of intravenous drug use and osteomyelitis was admitted with abscesses in the lumbar paraspinal region through to the gluteal region. She required surgical debridement, and her lower back pain was initially treated with Tylenol, baclofen, and oxycodone.

Discussion (relevance): Acute pain management involves a complex, multimodal treatment plan. This approach is further complicated with patients with a history of substance use disorder or NPO. The adverse risk of addiction to opioids cannot be minimized with these patients, limiting the options of medications that can be used in this setting. This case series sheds light on lidocaine infusion as an adjuvant treatment possible for those who are ineligible for or may not respond to current approaches.

Setting: Pediatric Intensive Care; Transitional Care

Assessment/Results The addition of Lidocaine infusion in the morning to the pain treatment plan of the 17-year-old female decreased the pain from 7/10 on the Modified Clinically Aligned Pain Assessment (MCAPA) scale to 4/10. Her 24-hour Dilaudid requirement decrease from 28 mg to 20 mg. For the 54-year-old female, the pain was unrelenting, even with increases in the dosage of medications and the addition of ibuprofen, gabapentin, and hydrocodone/acetaminophen. After lidocaine infusion, pain decreased from 5/10 to 4/10 on MCAPA with the patient noting that the pain is now tolerated. Once lidocaine infusion was discontinued, she complained of increased burning pain again which responded to oral Trileptal, another sodium channel blocker that can be given orally.

Conclusions: Physiatrists should be aware of the possible benefits of lidocaine infusion in acute pain relief with complex pain patients, including those with a history of substance use disorder or those who are NPO.