Lidocaine for pain relief in burn injured patients

Wasiak J, Cleland H

Published Online:

November 10, 2010

There are no clinically relevant randomised controlled trials showing that burns patients benefit from intravenous lidocaine for pain relief. Burns are very common, sometimes fatal, and the pain associated with such injury is one of the most difficult types of suffering to relieve. The use of high-dose opioid medications like morphine is common, but side effects are encountered. Alternative agents such as lidocaine, an anaesthetic, have been proposed. This review found no clinically relevant trials looking at the use of lidocaine to manage burn pain.

Abstract (click to read)

Background:

Pain is a major issue for patients suffering from many different types of wounds in particular those with burn injuries. Prompt, aggressive use of opioid analgesics such as morphine has been suggested as critical to avert the cycle of pain and anxiety, but side effects are encountered. It is proposed that newer agents such as lidocaine could be effective in reducing pain and alleviating the escalating opioid dosage requirements in patients with burn injury.

Objectives:

To assess the safety and effectiveness of intravenous lidocaine as a means of pain relief versus no therapy, placebo, other drugs or two or more of the above therapies in combination in patients exposed to burn injury.

Search strategy:

We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2007), MEDLINE (1966 to March 2007), EMBASE (1980 to 2007), CINAHL (1982 to March 2007).

Selection criteria:

Those trials that were considered were: randomised controlled trials (RCTs) and controlled clinical trials (CCTs), both published and unpublished studies, which assessed the efficacy of intravenous lidocaine varying doses as a single-agent therapy with no therapy, placebo, other analgesics such as opioids, lidocaine plus another drug, or two or more of the above therapies as a means of pain relief in patients exposed to burn injury.

Data collection and analysis:

The two review authors applied the entry criteria to identified studies.

Main results:

No clinically relevant RCTs or CCTs were identified through the above searches.

Authors' conclusions:

No information is available from the published RCTs or CCTs on clinically relevant primary outcome measures which can influence current burns care practice and management. Therefore, since current clinical evidence is subject to the inherent weaknesses of case series or reports, intravenous lidocaine must be considered a pharmacological agent under investigation in burns care whose effectiveness is yet to be determined in well-designed and conducted clinical trials.

This record should be cited as:

Wasiak J, Cleland H. Lidocaine for pain relief in burn injured patients. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD005622. DOI: 10.1002/14651858.CD005622.pub2

Assessed as up to date:

March 1, 2007

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Primary Review Group:

Pain, Palliative and Supportive Care Group

Health topics:

Anaesthesia & pain control > Acute pain > Pharmacological treatment

Orthopaedics & trauma > Acute pain > Pharmacological treatment

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Lidocaine for pain relief in burn injured patients

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