Intravenous Lidocaine in Management of Acute Pain in Traumatic Limb: Evidence-Based Systematic Review

Lidocaine is one of the medications that is proposed as an alternative in acute pain management. Lidocaine is routinely used in topical and dental anesthesia and is known for its analgesic effects. But various evidences are proposing an intravenous administration of lidocaine for pain management; while in acute limb pain, its safety, and efficacy are not reviewed yet. In this review study, PubMed, Medline, Scopus, and EMBASE were quarried for studies on an acute traumatic limb injury pain treated with intravenous lidocaine. Critical Appraisal Skills Program and GRADEpro tools were used to critically evaluate the collected literature based on the evidence-based approach. Recommendations were synthesized based on the highest levels of evidence.  Eleven studies were included in the review. While some studies were showing effective analgesic properties of intravenous lidocaine for pain relief in extremities when compared with conventional opioids, the ‎high rate of Adverse Events (AEs) reported in some studies and the need for a close observation of patients for major side effects restrict clinical application of the systemic lidocaine. ‎ Blood lidocaine level studies are required but are missing in the literature. ‎Post-operative outcomes of limb trauma patients who receive lidocaine are not clear. The AEs’ monitoring is not followed during the hospitalization or after discharge. Systematic review and meta-analyses on the topic are heterogeneous due to different indications of intravenous lidocaine administration.  Our systematic review of literature could draw the conclusion of cautions on high dose intravenous lidocaine administration due to potential side effects and unclear outcomes.