Intravenous lidocaine for acute pain: an evidence-based clinical update

Abstract

### Key points Poorly controlled acute pain remains one of the most undesirable consequences after surgery. Despite increased awareness and widespread efforts to address this, reports continue to estimate that a significant number of patients undergoing surgery experience moderate to severe pain, with a majority of them expressing dissatisfaction with their pain management.1 Advances in multimodal analgesia have largely replaced conventional opioid mono-therapy, but continued reliance on opioids to manage postoperative pain may at least partly explain the inadequacy of conventional acute pain management. Almost 30 yr ago, the well-known ‘WHO Step Ladder’ was introduced and has since become a widely accepted concept for rational pain management. This concept has had a major impact on developing the current rationale for the management of acute pain by introducing the concept of multimodal analgesia, highlighting the importance of determining pain severity, encouraging step-wise pain management, and suggesting a wider role for adjuvant agents. Even the origins of the more current concept of opioid-sparing analgesia can probably be traced back to this WHO Step Ladder. The role of analgesic adjuvants in perioperative pain management, notably ketamine, lidocaine, and the gabapentinoids, continues to be explored. In most situations, the use of these drugs allows for further significant decrease in the requirement or reliance on opioids for adequate …