Dramatic Response to Lidocaine Infusion for Pain from Brachial Plexus Avulsion Injury

BACKGROUND: Traumatic brachial plexus avulsion injury (tBPI) can cause a severe chronic pain syndrome that is very difficult to treat. Though lidocaine has been shown to be effective for other pain syndromes, effectiveness in tBPI has not previously been reported. CASE REPORT: A 55-year-old man with tBPI had severe pain and minimal relief with numerous analgesic agents. He was able to access intravenous lidocaine as he was being treated at a cancer center, and had a sustained response to 7 mg/kg given over an hour. CONCLUSION: There is potential for a single bolus intravenous lidocaine infusion to provide good pain control sustained over many months in patients with traumatic brachial plexus injury. An adequate serum concentration of lidocaine is required for analgesic effect. If initial doses of lidocaine are tolerated but ineffective, higher doses may still be beneficial. KEY WORDS: Brachial plexus avulsion, lidocaine, lignocaine, pain management, palliative care, therapeutics, trauma