Chu, Roberts, Johns Hopkins School of Medicine, Baltimore, MD, USA. Umukoro, Department of Anesthesia, Riley Hospital for Children, Indiana Health, Indianapolis, IN, USA. Greer, MD, Department of Transitional Year Residency Program, HCA Houston Healthcare, Kingwood, TX, USA. Adekoya, MD, Department of Anesthesia and Critical Care Medicine, Baltimore, MD, USA. Odonkor, MD, Department of Orthopedics and Rehabilitation, Division of Physical Medicine and Rehabilitation, Yale Medicine, Yale New Haven Health System, New Haven, CT, USA. Hagedorn, MD, Olatoye, MD, Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA. Urits, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA. Hasoon, MD, Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. Salisu Orhurhu, MD, MPH, Orhurhu, MD, MPH, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Umukoro, MD, Department of Nephrology, Indiana University School of Medicine, Indianapolis, IN, USA. Viswanath, MD, Department of Anesthesiology, Louisiana State University School of Medicine, Shreveport, LA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE. Kaye, MD, PhD, Departments of Anesthesiology and Pharmacology, Toxicology and Neurosciences, Louisiana State University School of Medicine, Shreveport, LA.
Psychopharmacol Bull. 2020 Oct 15;50(4 Suppl 1):216-259.
Previously used as anti-arrhythmic, intravenous lidocaine infusion is becoming popular for use in management of acute pain. There is still much to be understood about its pharmacokinetics and pharmacodynamics, especially with regard to optimal dosing to avoid side effects. In this article, we selected and reviewed randomized controlled trials to summarize the pharmacokinetics, antinociceptive effects, anti-hyperalgesic effects, anti-inflammatory effects, side effects, and role of intravenous lidocaine in the management of early postoperative pain. The mechanisms of action of lidocaine are still unclear but there are many theories postulated. Optimal dosing of lidocaine is not known but general consensus indicates that a loading dose of 1-2 mg/kg, followed by 1-2 mg/kg/hr continuous infusion during early postoperative pain control while recovering from anesthesia to achieve therapeutic levels of 0.5-5 mcg/kg clearly improves analgesia in the immediate postoperative period. Although lidocaine was initially studied and proven to have clear analgesic effects following laparoscopic and open abdominal surgeries, it has now been shown to be applicable in different clinical settings perioperatively including following spinal, breast, ENT and other surgeries. It is generally safe, with hypotension, headache and vomiting being the more common side effects. Serious adverse effects include cardiovascular block and arrhythmias, neuro-excitability and hypersensitivity, although the frequency of these are not known.
先前被用作抗心律失常药物的静脉利多卡因输注在急性疼痛管理中的应用越来越受欢迎。关于其药代动力学和药效学，特别是为避免副作用而选择最佳剂量，仍有许多需要了解的地方。本文我们选择并综述了随机对照试验，以总结利多卡因的药代动力学、镇痛作用、抗痛觉过敏作用、抗炎作用、副作用以及在早期术后疼痛管理中的作用。利多卡因的作用机制仍不清楚，但有许多理论假设。利多卡因的最佳剂量尚不清楚，但一般共识表明，在麻醉恢复期间，早期术后疼痛控制时，负荷剂量为 1-2mg/kg，然后以 1-2mg/kg/hr 持续输注，以达到 0.5-5mcg/kg 的治疗水平，可明显改善术后即刻的镇痛效果。尽管利多卡因最初的研究和证明在腹腔镜和开腹手术后具有明确的镇痛作用，但现在已经证明它在围手术期的不同临床环境中适用，包括脊柱、乳房、耳鼻喉科和其他手术。它通常是安全的，低血压、头痛和呕吐是更常见的副作用。严重的不良反应包括心血管阻滞和心律失常、神经兴奋性和过敏反应，尽管这些不良反应的频率尚不清楚。
