Cover image of the article: Effectiveness of intravenous lidocaine versus intravenous morphine in reducing acute extremity trauma-induced pain: A triple-blind randomized clinical trial

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Effectiveness of intravenous lidocaine versus intravenous morphine in reducing acute extremity trauma-induced pain: A triple-blind randomized clinical trial

Authors

Mahdi ForoughianMahdi Foroughian ORCID, Samaneh Abiri, Hamideh AkbariHamideh Akbari ORCID, Vajiheh Shayesteh Bilandi, Seyed Reza Habibzadeh, Fatemeh Alsana, Razieh Naseri, Navid KalaniNavid Kalani ORCID, Esmaeil Rayat Dost,*
*Corresponding Author: Email: e.rayat.dost@gmail.com

Koomesh:Vol. 22, issue 3; 411-418
Published online:Sep 01, 2020
Article type:Research Article
Received:Nov 01, 2019
Accepted:Jan 01, 2020
How to Cite:Foroughian M, Abiri S, Akbari H, Shayesteh Bilandi V, Habibzadeh SR, et al. Effectiveness of intravenous lidocaine versus intravenous morphine in reducing acute extremity trauma-induced pain: A triple-blind randomized clinical trial. koomesh. 2020;22(3):e153196. doi:

Abstract

Introduction: The present study aimed to compare analgesic effects of IV lidocaine vs. IV morphine on the management and relief of acute pain caused by the extremity trauma. Materials and Methods: The present study was a triple-blind randomized clinical trial that was conducted in the emergency department of Peymanieh Hospital of Jahrom. Patients aged 16 to 65 with acute extremity traumas and the need for pain control were eligible for the study. Meaningly, one group received IV Lidocaine (1.5 mg/kg) and another group received IV Morphine (0.1 mg/kg). Pain scores, side effects, and vital signs were evaluated in the admission, and 15, 30, 45, and 60 minutes after the injection. Data were analyzed by descriptive and inferential statistical tests in SPSS software at a significant level of P< 0.05. Results: 60 patients with a mean age of 35.31 ± 11.10 years were included in the study. Correspondingly, demographic characteristics and pain scores were similar in both groups. Median pain was higher in the intravenous morphine group than the Lidocaine group at the 15th minute after the injection (P= 0.035), but it was higher in the Lidocaine group than the IV morphine group at the 60th minute after the injection (P= 0.045). There was no significant difference between research groups at other times. Furthermore, there was a significant difference between IV Lidocaine and morphine in terms of pulse rates during the drug injection (P= 0.012), but no significant difference was seen in terms of their side effects (P>0.05). Conclusion: Based on the research results, IV Lidocaine could be considered as an appropriate alternative for the emergency pain management in the emergency department.  

Highlights

References

  • 1.
    Smith JE, Rockett M, Creanor S, Squire R, Hayward C, Ewings P, et al. PAin SoluTions In the Emergency Setting (PASTIES)patient controlled analgesia versus routine care in emergency department patients with pain from traumatic injuries: randomised trial. BMJ 2015; 350: h2988.
  • 2.
    Marinangeli F, Narducci C, Ursini ML, Paladini A, Pasqualucci A, Gatti A, et al. Acute pain and availability of analgesia in the prehospital emergency setting in Italy: a problem to be solved. Pain Practice 2009; 9: 282-288.
  • 3.
    Marinangeli F, Reggiardo G, Sblendido A, Soldi A, Farina A, Group M. Prospective, multicentre trial of methoxyflurane for acute trauma-related pain in helicopter emergency medical systems and hostile environments: METEORA Protocol. Adv Ther 2018; 35: 2081-2092.
  • 4.
    Dimann PD, Maignan M, Cloves PD, Parres BG, Dickerson S, Eberhardt A. A review of the burden of trauma pain in emergency settings in Europe. Pain Ther 2018; 7: 179-192.
  • 5.
    Eidenbenz D, Taffe P, Hugli O, Albrecht E, Pasquier M. A twoyear retrospective review of the determinants of prehospital analgesia administration by alpine helicopter emergency medical physicians to patients with isolated limb injury. Anaesthesia 2016; 71: 779-787.
  • 6.
    Mura P, Serra E, Marinangeli F, Patti S, Musu M, Piras I, et al. Prospective study on prevalence, intensity, type, and therapy of acute pain in a second-level urban emergency department. J Pain Res 2017; 10: 2781.
  • 7.
    Wu CL, Raja SN. Treatment of acute postoperative pain. The Lancet 2011; 377: 2215-2225.
  • 8.
    Vanstone RJ, Rockett M. Use of atypical analgesics by intravenous infusion (IV) for acute pain: evidence base for lidocaine, ketamine and magnesium. Anaesth Inten Care Med 2016; 17: 460-463.
  • 9.
    Farag E, Ghobrial M, Sessler DI, Dalton JE, Liu J, Lee JH, et al. Effect of perioperative intravenous lidocaine administration on pain, opioid consumption, and quality of life after complex spine surgery. Anesthesiology 2013; 119: 932-940.
  • 10.
    Godarzi M, Abbasi Maleki S, Mousavi S Z, Moradi Kor N. Morphine withdrawal symptoms improvement by Ziziphora tenuior L. ethanoic extract in male mice. Koomesh 2016; 17: 990-995. (Persian).
  • 11.
    Talebi-Keyasari F, Heidari S, Mehdinejad M, Miladi-Gorji H. Effects of forced treadmill exercise during the induction of morphine dependence on the severity of physical and psychological dependence in morphine-dependent rats. Koomesh 2017; 19: 648-654. (Persian).
  • 12.
    Dinges HC, Otto S, Stay DK, Bumlein S, Waldmann S, Kranke P, Wulf HF, Eberhart LH. Side effect rates of opioids in equianalgesic doses via intravenous patient-controlled analgesia: a systematic review and network meta-analysis. Anesth Analg 2019; 129: 1153-1162.
  • 13.
    Beaudoin FL, Haran JP, Liebmann O. A comparison of ultrasoundguided threeinone femoral nerve block versus parenteral opioids alone for analgesia in emergency department patients with hip fractures: a randomized controlled trial. Acad Emerg Med 2013; 20: 584-591.
  • 14.
    Sahota O, Rowlands M, Bradley J, Van de Walt G, Bedforth N, Armstrong S, et al. Femoral nerve block Intervention in Neck of Femur fracture (FINOF): study protocol for a randomized controlled trial. Trials 2014; 15: 189.
  • 15.
    Clattenburg EJ, Nguyen A, Yoo T, Flores S, Hailozian C, Louie D, et al. Intravenous Lidocaine Provides Similar Analgesia to Intravenous Morphine for Undifferentiated Severe Pain in the Emergency Department: A Pilot, Unblinded Randomized Controlled Trial. Pain Med 2018; 20: 834-839.
  • 16.
    Soleimanpour H, Hassanzadeh K, Vaezi H, Golzari SE, Esfanjani RM, Soleimanpour M. Effectiveness of intravenous lidocaine versus intravenous morphine for patients with renal colic in the emergency department. BMC Urol 2012; 12: 13.
  • 17.
    Tanen DA, Shimada M, Danish DC, Dos Santos F, Makela M, Riffenburgh RH. Intravenous lidocaine for the emergency department treatment of acute radicular low back pain, a randomized controlled trial. J Emerg Med 2014; 47: 119-124.
  • 18.
    Vahidi E, Shakoor D, Meybodi MA, Saeedi M. Comparison of intravenous lidocaine versus morphine in alleviating pain in patients with critical limb ischaemia. Emerg Med J 2015; 32: 516-519.
  • 19.
    Masic D, Liang E, Long C, Sterk EJ, Barbas B, Rech MA. Intravenous lidocaine for acute pain: a systematic review. Pharmacotherapy 2018; 38: 1250-1259.
  • 20.
    Chinn E, Friedman BW, Naeem F, Irizarry E, Afrifa F, Zias E, et al. Randomized trial of intravenous lidocaine versus hydromorphone for acute abdominal pain in the emergency department. Ann Emerg Med 2019; 74: 233-240.
  • 21.
    Choi KW, Nam KH, Lee JR, Chung WY, Kang SW, Joe YE, et al. The effects of intravenous lidocaine infusions on the quality of recovery and chronic pain after robotic thyroidectomy: a randomized, double-blinded, controlled study. World J Surg 2017; 41: 1305-1312.
  • 22.
    Farahmand S, Hamrah H, Arbab M, Sedaghat M, Ghafouri HB, Bagheri-Hariri S. Pain management of acute limb trauma patients with intravenous lidocaine in emergency department. Am J Emerg Med 2018; 36: 1231-1235.
  • 23.
    Moulin DE, Morley-Forster PK, Pirani Z, Rohfritsch C, Stitt L. Intravenous lidocaine in the management of chronic peripheral neuropathic pain: a randomized-controlled trial. Can J Anaesth 2019; 66: 820-827.
  • 24.
    Geier DA, Kern JK, Davis G, King PG, Adams JB, Young JL, et al. A prospective double-blind, randomized clinical trial of levocarnitine to treat autism spectrum disorders. Med Sci Monit 2011; 17: PI15-23.
  • 25.
    Firouzian A, Alipour A, Dezfouli HR, Kiasari AZ, Baradari AG, Zeydi AE, et al. Does lidocaine as an adjuvant to morphine improve pain relief in patients presenting to the ED with acute renal colic? A double-blind, randomized controlled trial. Am J Emerg Med 2016; 34: 443-448.
  • 26.
    Ayulo Jr MA, Phillips KE, Tripathi S. Safety and efficacy of IV Lidocaine in the treatment of children and adolescents with status migraine. Pediatr Crit Care Med 2018; 19: 755-759.
  • 27.
    Greenwood E, Nimmo S, Paterson H, Homer N, Foo I. Intravenous lidocaine infusion as a component of multimodal analgesia for colorectal surgerymeasurement of plasma levels. Perioper Med (Lond) 2019; 8: 1.
  • 28.
    Ibrahim A, Aly M, Farrag W. Effect of intravenous lidocaine infusion on long-term postoperative pain after spinal fusion surgery. Medicine 2018; 97.
  • 29.
    Gholipour Baradari A, Firouzian A, Hasanzadeh Kiabi F, Emami Zeydi A, Khademloo M, Nazari Z, et al. Bolus administration of intravenous lidocaine reduces pain after an elective caesarean section: Findings from a randomised, double-blind, placebo-controlled trial. J Obstet Gynaecol 2017; 37: 566-570.
  • 30.
    van den Heuvel SA, van der Wal SE, Smedes LA, Radema SA, Alfen Nv, Vissers KC, et al. Intravenous lidocaine: old-school drug, new purposereduction of intractable pain in patients with chemotherapy induced peripheral neuropathy. Pain Res Manag 2017; 2017: 8053474.
  • 31.
    Forouzan A, Barzegari H, Motamed H, Khavanin A, Shiri H. Intravenous lidocaine versus morphine sulfate in pain management for extremity fractures; a clinical trial. Emergency 2017; 5: e68.
  • 32.
    Zhao JB, Li YL, Wang YM, Teng JL, Xia DY, Zhao JS, et al. Intravenous lidocaine infusion for pain control after laparoscopic cholecystectomy: A meta-analysis of randomized controlled trials. Medicine 2018; 97.
  • 33.
    Foruzeshfard M, Miladi Gorji H. Effect of Cimetidine antinociception on post operative pain and comparison with morphine . Koomesh 2006; 7: 1-6. (Persian).
  • 34.
    e Silva LOJ, Scherber K, Cabrera D, Motov S, Erwin PJ, West CP, et al. Safety and efficacy of intravenous lidocaine for pain management in the emergency department: a systematic review. Ann Emerg Med 2018; 72: 135-144.e3.
  • 35.
    Torp KD, Simon LV. Lidocaine Toxicity. Stat Pearls [Internet]: Stat Pearls Publishing; 2018.
  • 36.
    Ho CM, Wu HL, Ho ST, Wang JJ. Dexamethasone prevents postoperative nausea and vomiting: benefit versus risk. Acta Anaesthesiol Taiwan 2011; 49: 100-104.
  • 37.
    Werdehausen R, Mittnacht S, Bee LA, Minett MS, Armbruster A, Bauer I, et al. The lidocaine metabolite N-ethylglycine has antinociceptive effects in experimental inflammatory and neuropathic pain. Pain 2015; 156: 1647.
  • 38.
    Dunn LK, Durieux ME. Perioperative use of intravenous lidocaine. Anesthesiology 2017; 126: 729-737.

Copyright

© 2020, Author(s). This open-access article is available under the Creative Commons Attribution 4.0 (CC BY 4.0) International License (https://creativecommons.org/licenses/by/4.0/), which allows for unrestricted use, distribution, and reproduction in any medium, provided that the original work is properly cited.

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