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lidocaine IV

      Re: lidocaine IV

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Posted by ccf neuro M.D.* on August 18, 1997 at 17:58:30:

In Reply to: lidocaine IV posted by Marjorie Kravitz on August 18, 1997 at 09:14:22:
  What is the general experience with lidocaine IV for burning painful feet?
  If effective, it would eliminate the need to take anti-depressants, anti-convulsants, and other drugs like alpha blockers that have a tendency to make people drowsy.
I have never heard of using IV lidocaine for treating symptoms of peripheral neuropathy, probably because I think most physicians would first try the oral version of it known as Mexilitine, which is often an effective and nonsedating treatment for the condition,  before resorting to IV infusion of a drug, which despite its anesthetic effect, also may cause seizures and arrhythmias of the heart, amongst other side effects, especially when administered IV. There is such a thing as a BAER block, in which the lidocaine is instilled into a vein of the affected extremity, and it is then tourniqueted off for a while to let the lidocaine anesthetize the nerve endings without escaping too quickly to the rest of the body, but no controlled studies exist to the best of my knowledge in using such blocks for the treatment of neuropathy, the number one cause by far of burning sensations in the feet. If you are having trouble with antidepressants, sometimes an "activating" antidepressant such as Wellbutrin (bupropion) is an alternative. Application of capscaicin cream (i.e. Zostrix) is another simple, topical measure that often affords considerable relief from such discomfort. The good news about such painful burning type neuropathies is that eventually the damage to the small nerve fibers that generate the painful burning sensation progresses to the point that they cease functioning entirely, at which time the pain is replaced by numbness, which while not optimal, beats having pain all the time. This process of the nerve endings "burning out" typically takes a few years. I could not in good conscience recommend IV lidocaine as anything other than a last ditch third or fourth line treatment for this condition to anyone, as many safer and more effective (longer lasting relief) options exist, and nearly everyone finds at least one drug that is helpful without intolerable side effects. Information provided on the CCF neurology forum is intended for general medical informational purposes only, and is not a substitute for your physician. Actual diagnosis and treatment of your specific condition should be strictly in conjunction with your treating physician. If you are interested in an evaluation at the Cleveland Clinic department of Neurology, the number is 1-800-223-2273 ext. 45559, or (direct#) (216)-444-5559. We hope you find the information provided interesting and useful.

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