Subcutaneous Lidocaine Infusion for Complex Cancer Pain: A Retrospective Review

This retrospective review assesses the safety and efficacy of subcutaneous lidocaine infusions for complex cancer pain, in a specialist palliative care unit. A retrospective chart review was undertaken of 18 infusions over a 2-year period. Data collected included patient demographics, use of adjuvant analgesics, methadone use and opioid requirements (as oral morphine equivalent daily dose, oMEDD) at three time periods: 24 hours prior to starting infusion, 24 hours after starting infusion and 24 hours after stopping infusion. Data was collected on infusion characteristics, adverse events and the patient's perception of lidocaine efficacy. Eighteen infusions were analyzed; all patients had metastatic cancer with 83.3% having stage IV disease. The majority of patients were prescribed three or more adjuvant analgesics, in addition, methadone was prescribed in 16 oMEDD use both 24 hours after starting, and 24 hours after stopping the lidocaine infusions. Events were reported in three out of 18 infusions, only one minor adverse event was attributed to lidocaine. Thirteen out of 18 infusions were perceived, by patients, to be effective for pain. This retrospective review has shown that a subcutaneous lidocaine infusion is a safe and effective means of managing complex cancer pain in a specialist palliative care unit.