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PAIN MEDICINE

Systemic Administration of Local Anesthetics to Relieve Neuropathic Pain: A Systematic Review and Meta-Analysis

Ivo W. Tremont-Lukats, MD^*, Vidya Challapalli, MD, Ewan D. McNicol, RPh, MS, Joseph Lau, MD, and Daniel B. Carr, MD

*Department of Neurology, Medical University of South Carolina, Charleston, SC; Department of Anesthesiology and Critical Care, University of Chicago Hospitals, Chicago, IL; Department of Anesthesiology, and Institute for Clinical Research and Health Policy Studies Tufts-New England Medical Center, Boston, MA

Address correspondence and reprint requests to Ewan McNicol, RPh, MS, Department of Anesthesia, #298, Tufts-New England Medical Center, 750 Washington Street, Boston, MA 02111. Address e-mail to emcnicol{at}tufts-nemc.org

We reviewed randomized controlled trials to determine the efficacy and safety of systemically administered local anesthetics compared with placebo or active drugs. Of 41 retrieved studies, 27 trials of diverse quality were included in the systematic review. Ten lidocaine and nine mexiletine trials had data suitable for meta-analysis (n = 706 patients total). Lidocaine (most commonly 5 mg/kg IV over 30-60 min) and mexiletine (median dose, 600 mg daily) were superior to placebo (weighted mean difference on a 0-100 mm pain intensity visual analog scale = –10.60; 95% confidence interval: –14.52 to –6.68; P < 0.00001) and equal to morphine, gabapentin, amitriptyline, and amantadine (weighted mean difference = –0.60; 95% confidence interval: –6.96 to 5.75) for neuropathic pain. The therapeutic benefit was more consistent for peripheral pain (trauma, diabetes) and central pain. The most common adverse effects of lidocaine and mexiletine were drowsiness, fatigue, nausea, and dizziness. The adverse event rate for systemically administered local anesthetics was more than for placebo but equivalent to morphine, amitriptyline, or gabapentin (odds ratio: 1.23; 95% confidence interval: 0.22 to 6.90). Lidocaine and mexiletine produced no major adverse events in controlled clinical trials, were superior to placebo to relieve neuropathic pain, and were as effective as other analgesics used for this condition.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999