1 Pharmacy Department, Spectrum Health Hospitals , Grand Rapids, Michigan.
2 Cancer and Hematology Centers of West Michigan , P.C., Grand Rapids, Michigan.
J Palliat Med. 2019 Mar;22(3):343-347. doi: 10.1089/jpm.2018.0243. Epub 2018 Dec 1.
Intravenous lidocaine is an option for intractable pain caused by advancing cancer and wound care. We report a case of intractable cancer pain and wound care pain managed with concurrent use of lidocaine administered as a twice daily intravenous bolus in addition to continuous intravenous infusion.
A 31-year-old male with rapidly progressing locally advanced squamous cell cancer affecting the gluteal area developed extensive painful and purulent ulcerating wounds affecting the coccyx, superior gluteal cleft, and buttocks. Laboratory tests were within normal limits, except for low albumin results. The patient's Palliative Performance Score was 60%. A trial of intravenous lidocaine 150 mg administered twice daily before dressing changes improved analgesia according to the patient's report. For additional improvement, a continuous intravenous infusion of lidocaine 1 mg/minute was initiated, in addition to the twice daily bolus infusions of lidocaine. The patient's pain score with dressing changes improved from 8-10 of 10 to 4-5 of 10 within 24 hours after initiation of the continuous intravenous lidocaine infusion. Lidocaine infusion was administered for a period of 45 days with targeted lidocaine blood levels not exceeding 5 mcg/mL. Twice daily lidocaine bolus infusions before dressing changes were administered for a total duration of 63 days. The lidocaine continuous intravenous infusion was discontinued on day 45 of therapy as a potential contributing factor to central nervous system adverse effects and in anticipation of transition to a subacute rehabilitation facility.
Intravenous lidocaine added to the efficacy of standard analgesic medications and nerve block procedures in our patient. This case demonstrates increasing blood lidocaine levels with continuous intravenous infusion despite stable clinical parameters and laboratory markers of major organ function. Monitoring lidocaine levels is a prudent course of action to identify drug accumulation with administration of lidocaine by continuous intravenous infusion.
静脉注射利多卡因是治疗进展性癌症引起的难治性疼痛和伤口护理的一种选择。我们报告了一例难治性癌症疼痛和伤口护理疼痛的病例，该病例通过同时使用利多卡因治疗，除了持续静脉输注外，还每天两次静脉推注。
一名 31 岁男性，患有快速进展的局部晚期鳞状细胞癌，影响臀部区域，他发展出广泛的疼痛和化脓性溃疡性伤口，影响尾骨、臀上裂和臀部。实验室检查除白蛋白结果偏低外，均在正常范围内。患者的姑息治疗表现评分为 60%。在换药前每天两次静脉注射 150mg 利多卡因的试验改善了患者的镇痛效果。为了进一步改善，在开始持续静脉输注利多卡因的同时，还开始每天两次静脉推注利多卡因 1mg/min。在开始持续静脉输注利多卡因后的 24 小时内，患者的换药疼痛评分从 10 分的 8-10 分改善至 4-5 分。在 45 天的时间里给予利多卡因静脉输注，目标血药浓度不超过 5 mcg/mL。每天两次静脉推注利多卡因在换药前共给药 63 天。由于潜在的中枢神经系统不良反应和预期过渡到亚急性康复机构，在治疗的第 45 天停止了利多卡因持续静脉输注。
静脉注射利多卡因增加了我们患者标准镇痛药物和神经阻滞程序的疗效。本病例显示，尽管临床参数和主要器官功能的实验室标志物稳定，但连续静脉输注时血利多卡因水平升高。监测利多卡因水平是一种谨慎的做法，可以识别连续静脉输注利多卡因时药物积累。
