Systemic intravenous lidocaine for perioperative pain management: a call for changing indications in the package sheet

Heart, Lung and Vessels. 2014, Vol. 6 Corresponding author: Paolo Grassi, M.D. Department of Anesthesia and Intensive Care Azienda Ospedaliero-Universitaria “Ospedali Riuniti” 34142 Trieste, Italy e-mail: [email protected] Obtaining adequate analgesia after major surgery is a problematic issue and postoperative pain still imposes a major burden of suffering on surgical patients (1). Intravenous patient-controlled opioids and epidural local anesthetics, the mainstay modalities in acute surgical pain treatment, expose the patients to potentially serious side effects (2). The perioperative administration of systemic intravenous lidocaine has been shown to be an effective method in postoperative pain management with a favorable effect on pain scores, opioid consumption and recovery after surgery without any clear evidence of harm (3, 4). Although the current literature is univocal about its efficacy and safety (5-7), the systemic intravenous use for perioperative pain management is still not mentioned in the lidocaine package sheet. We believe that this fact, leading health practitioners to deal with the risks of an off-label prescription, hampers the diffusion of an effective, safe, simple, cheap and widely accessible method of perioperative pain control. With millions of major surgical interventions carried out every year it is reasonable to speculate that pharmaceutical companies will deSystemic intravenous lidocaine for perioperative pain management: a call for changing indications in the package sheet