Intravenous lidocaine for the treatment of background or procedural burn pain.

This is an update of the review on 'Lidocaine for pain relief in burn injured patients' first published in Issue 3, 2007. Pain is a major issue for patients suffering from many different types of wounds, in particular those with burn injuries. Prompt, aggressive use of opioid analgesics such as morphine has been suggested as critical to avert the cycle of pain and anxiety, but side effects are encountered. It is proposed that newer agents such as lidocaine could be effective in reducing pain and alleviating the escalating opioid dosage requirements in patients with burn injury. To assess the safety and effectiveness of intravenous lidocaine as a means of pain relief versus no therapy, placebo, other drugs or two or more of the above therapies in combination in patients exposed to burn injury. We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library 2011, Issue 2), MEDLINE (1966 to April 2011 week 4) and EMBASE (1980 to 2011 week 17). We included randomised controlled trials (RCTs) and controlled clinical trials (CCTs), published and unpublished, which assessed the efficacy of intravenous lidocaine in varying doses as a single-agent therapy with no therapy, placebo, other analgesics such as opioids, lidocaine plus another drug, or two or more of the above therapies as a means of pain relief in patients exposed to burn injury. Two review authors independently abstracted data and assessed the risk of bias of the studies identified. This update identified one new randomised, double-blind, placebo-controlled, cross-over trial which included 45 participants and compared intravenous lidocaine against placebo as a means of pain relief in those with burns. Subjective pain ratings as measured by the verbal rating scale increased during procedures for both treatment arms, however, the increase was less for the lidocaine treatment arm. There were no significant clinical or statistical differences regarding the effects of lidocaine and placebo on opioid requests and consumption, anxiety or level of satisfaction during a wound care procedure. As current clinical evidence is based on only one single RCT as well as case series and reports, intravenous lidocaine must be considered a pharmacological agent under investigation in burns care, the effectiveness of which is yet to be determined with further well-designed and conducted clinical trials.