Lidocaine Opioids

LOAD mnemonic for pretreatment for rapid sequence intubation Lidocaine, Opioids, Atropine, Defasciculating agent LOC loss of consciousness, level of consciousness... 

Smoking cessation, with or without nicotine substitutes, may alter response to concomitant medication in ex-smokers. Smoking may affect alcohol, benzodiazepines, beta-adrenergic blockers, caffeine, clozapine, fluvoxamine, olanzapine, tacrine, theophylline, clorazepate, lidocaine (oral), estradiol, flecanide, imipramine, heparin, insulin, mexiletine, opioids, propranolol, catecholamines, and cortisol. 

A period of 1-3 weeks may be required to observe a therapeutic effect after introduction of the local anesthetic in patients with neuropathic pain. Recent studies suggest that intravenous lidocaine may be useful as an adjuvant for reducing acute pain in the perioperative period. As a result of its opioid-sparing effects, use of intravenous lidocaine has been found to facilitate recovery of bowel function and lead to an earlier discharge after abdominal surgery. 

Medication trials Lidocaine Gabapentin Mexilitine Opioid... 

A synergistic interaction of intrathecal fentanyl 100 pg and morphine 0.5 mg, given before induction, with systemically administered lidocaine 200 mg 4 hours later for ventricular tachycardia, resulted in potentiation of opioid effects in a 74-year-old man with major heart disease after coronary artery bypass grafting during the 5 minutes after lidocaine he had a respiratory arrest with loss of consciousness and miotic pupils, all reversed by naloxone (80). The proposed mechanism was thought to be a reduction in calcium ion concentrations in opioid-sensitive CNS sites. 

Jensen E, Nader ND. Potentiation of narcosis after intravenous lidocaine in a patient given spinal opioids. Anesth Analg I999 89(3) 758-9. 

An isobaric solution of sameridine given intrathecally in doses of 15, 20, and 23 mg has been compared with hyperbaric lidocaine 100 mg in 100 volunteers (178). Sameridine has both local anesthetic and opioid analgesic properties. There was one incident of transient paresthesia with sameridine 20 mg and two cases of bradycardia with lidocaine the incidence of hypotension was more frequent with lidocaine, but pruritus was more common with sameridine. 

Opioids potentiate the analgesic effect of neuraxial local anesthetics, with minimal adverse effects (SEDA-18,141) (SEDA-20, 121) (SEDA-22, 135), as shown in several studies with clonidine, fentanyl, morphine, or pethidine as the systemic or neuraxial analgesic, and bupivacaine, lidocaine, and ropivacaine as the local anesthetic. The benefits have been shown in relief of long-term pain and postoperative pain, in adults and children (SEDA-18, 141) (SEDA-18,146). 

Nerve blocks can be given in cases of very painful outbreaks. A mixture of lidocaine with adrenaline (epinephrine) and ropivacaine or bupivacaine" can be used. In some cases, the doctor will have to prescribe opioids to relieve severe pain. However, treatment with opioids might well get rid of the pain but will not affect the itching. It could even aggravate the pruritus. The itching sometimes resists hydroxyzine and diphenhydramine. Asken reported that he once had to inject propanolol intravenously to relieve unbearable pruritus. 

D6 Amiodarone, cimetidine, quinidine, SSRIs Antidepressants, flecainide, lidocaine, mexiletine, opioids... 

Aspirate the catheter, and test with local anesthetic (4-6 mL lidocaine 1% with epi, or lidocaine 1% with epi combined with bupivacaine 0.25% with epi). The patient must be closely observed for the next 20 minutes. If pain relief or a drop in BP is not observed within 10 minutes, pull out the epidural catheter, administer IV opioids and consider immediate replacement of the epidural If the catheter cannot be replaced. 

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