Simultaneous Application of Lidocaine and Ketamine During Ambulatory Infusion Therapy: A Retrospective Analysis

Abstract

Background: Infusions with lidocaine or ketamine have been separately established in the treatment of chronic pain. This study aims to retrospectively evaluate the effect of combined infusions of lidocaine and ketamine. Materials & methods: Patient records were screened for receipt of combined ambulatory infusions of lidocaine and ketamine from 2012 through 2021. A scoring system was designed to assess pain response retrospectively. Results: A total of 319 patients were included. Median pain reduction in days was 10.00 (interquartile range: 13.25). Side effects were limited to the acute phase of infusions. A total of 41.4% of patients who received concomitant pain medication reported a dose reduction. Conclusion: Our data support combined infusions as a safe therapy option, with good short-, medium- and long-term reductions in pain and great heterogeneity in treatment response.

Clinical trial registration: ClinicalTrials.gov (NCT05103319)

Tweetable abstract

Combined treatment with intravenous lidocaine and ketamine can be a safe option in the treatment of refractory chronic pain. Prospective data are needed to predict treatment response in a heterogeneous group of pain patients.

Plain language summary

What is this study about?

This study examined data of patients with chronic pain who received an infusion at our hospital with two drugs, lidocaine and ketamine, in an effort to reduce pain. We examined the records of 319 patients and a total of 2995 infusion protocols to gather our data. We wanted to know how much and for how long pain was reduced by these infusions. Additionally, we tried to identify the specific features of patients who profited the most during our infusions. We also had a look at the side effects of the infusions and wanted to know if patients could reduce their daily pain medication intake when receiving infusions.

What were the results?

On average, people had less pain for 10 days after the infusions. Women seemed to benefit more than men. Otherwise, we were unable to identify specific features that predicted how much a patient would benefit. Side effects occurred only during the infusions and for a short period afterward. In addition, 41.4% of patients who took pain medication daily were able to reduce their intake.

What do the results mean?

These results support our clinical experience that infusions with lidocaine and ketamine are safe and can contribute to reduced pain in patients with chronic pain, at least in the short term, and for some patients even longer.

Keywords::

• chronic pain
• infusion therapy
• ketamine
• lidocaine
• pain reduction

Supplementary data

To view the supplementary data that accompany this paper please visit the journal website at: www.tandfonline.com/doi/suppl/10.2217/pmt-2023-0037

Author contributions

All authors contributed to the conception of the study. The data collection was executed by J Striebel. Both T Schneider and J Striebel contributed to the writing process. W Ruppen revised the manuscript critically.

Acknowledgments

The authors thank A Dwileski (scientific assistant), Clinic for Anesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland, for providing editorial assistance.

Financial disclosure

Support for this study was provided solely by the Pain Unit, Clinic for Anesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript.

Competing interests disclosure

The authors have no competing interests or relevant affiliations with anyorganization or entity with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Writing disclosure

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. In addition, for investigations involving human subjects, informed consent has been obtained from the participants involved.

Data sharing statement

The authors certify that this manuscript reports original clinical trial data. Deidentified, individual data that underlie the results reported in this article (text, tables, figures and appendices) along with the study protocol will be available indefinitely to any researcher who wants access to them.

Additional information

Funding

Support for this study was provided solely by the Pain Unit, Clinic for Anesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript.