Effectiveness and safety of intravenous lidocaine in the analgesic management of acute pancreatitis: A retrospective study.

Abstract

Introduction: Intravenous (IV) lidocaine has both analgesic and anti-inflammatory effects. Its use has never been evaluated for analgesia for patients with acute pancreatitis (AP). We aimed to evaluate the effectiveness and safety of IV lidocaine in the management of AP resistant to weak opioids.

Materials and methods: We conducted a retrospective, monocentric study between January 2015 and December 2021 that included consecutive patients with (i) AP and (ii) pain resistant to non-opioid and weak-opioid analgesia (tramadol) (iii) treated with IV lidocaine. The effectiveness of the treatment was defined as a decrease in the numerical pain scale (NPS) of at least one point from the initiation of lidocaine and the absence of a need for opioid analgesia (morphine or oxycodone).

Results: In total, 154 patients were included. The patients were predominantly male (69 %), with a median age of 48.5 years [37.0; 58.0]. The main etiology of AP was alcoholic (36 %), and necrotizing AP was observed for 69 % of patients. Lidocaine was continuously administered at a dose of 2 g/24 h. Lidocaine treatment was effective for 88.3 % of patients (136/154). The median score on the NPS before the administration of lidocaine was 8.0 [7.0; 9.0] and significantly decreased to 5.8 [4.5; 7.0] by day 1 (p < 0.001). No factors were associated with lidocaine failure. Two (1.3 %) patients experienced lidocaine-related adverse events, including skin rash and dysgeusia, and no severe adverse events were observed.

Conclusion: IV lidocaine administration appears to be effective and safe for patients with AP with pain resistant to weak-opioid analgesia. Further prospective studies are needed to confirm these results.