Abstract
Introduction: Lung transplantation is associated with severe pain, which can delay recovery. Systemic lidocaine has useful analgesic properties for managing acute pain, however little is known on its use after lung transplantation. Due to pharmacological alterations during the postoperative period, the use of analgesics implies a demanding process to avoid toxicity, so lidocaine may play a role in this scenario. In this sense, the purpose of this case report is to present the use of systemic lidocaine as an option for the management of acute pain when other analgesics have failed to do so.Case presentation: The case of a male patient with acute pain in the postoperative period of single-lung transplantation is presented. Opioids and non-opioid analgesics showed limited efficacy, so the systematic administration of lidocaine was decided. Systemic lidocaine was effective for pain control, functional recovery and opioid decrease during the postoperative period.Conclusions: Systemic lidocaine was a useful drug for postoperative pain management in lung transplantation, since it allowed adequate analgesia and lung function recovery with decreased use of opioids. This drug may be a component of multimodal analgesia in selected patients when other options have failed; however its routine use is not recommended.
Highlights
IntroductionPulmonary fibrosis is a low-incidence disease —97.3 cases per 100 000/year— that generates a heavy burden for patients, their families and society.[1]
Lung transplantation is associated with severe pain, which can delay recovery
Systemic administration of lidocaine was a useful alternative for achieving optimal postoperative pain management in lung transplantation, since it allowed adequate analgesia and lung function recovery with decreased use of opioids
Summary
Pulmonary fibrosis is a low-incidence disease —97.3 cases per 100 000/year— that generates a heavy burden for patients, their families and society.[1]. The purpose of this report is to show the use of systemic lidocaine as an option to treat severe, uncontrolled postoperative pain in selected patients after lung transplantation, when other analgesic options have failed This is the case of a 30-year-old male patient, with a five-year history of idiopathic progressive pulmonary fibrosis; his main symptoms included dyspnea, even at rest, which required increasing doses of oxygen, persistent dry cough, fatigue, loss of weight, insomnia, incidental severe sharp pain in the limbs, and depressed mood. His pulmonary function tests showed a restrictive pattern, a forced vital capacity of 2 350 mL, a six-minute walk test (SMWT) of 383 meters, and oxygen saturation on exertion of 84%. The patient was satisfied with the analgesic treatment and no side effects associated with systemic lidocaine administration were reported
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