Lidocaine for Cancer Pain in Adults: A Systematic Review and Meta-Analysis

Lee, JT; Sanderson, CR; Xuan, W; Agar, M

Lidocaine for Cancer Pain in Adults: A Systematic Review and Meta-Analysis

Lee, JT

Sanderson, CR

Xuan, W Agar, M

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Publication Type:: Journal Article
Citation:: Journal of Palliative Medicine, 2019, 22 (3), pp. 326 - 334
Issue Date:: 2019-02-22

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Field	Value	Language
dc.contributor.author	Lee, JT https://orcid.org/0000-0003-1570-066X	en_US
dc.contributor.author	Sanderson, CR https://orcid.org/0000-0001-5423-5778	en_US
dc.contributor.author	Xuan, W	en_US
dc.contributor.author	Agar, M https://orcid.org/0000-0002-6756-6119	en_US
dc.date.issued	2019-02-22	en_US
dc.identifier.citation	Journal of Palliative Medicine, 2019, 22 (3), pp. 326 - 334	en_US
dc.identifier.issn	1096-6218	en_US
dc.identifier.uri	http://hdl.handle.net/10453/135486
dc.description.abstract	© 2019, Mary Ann Liebert, Inc. Background: Internationally, use of lidocaine infusions to treat cancer pain varies by center. Existing systematic reviews do not adequately inform use of lidocaine in cancer pain. Objective: To assess the effects of systemic sodium channel blockers on cancer pain in adults, review the dose protocols for administration, and assess toxicity. Design: Databases CENTRAL, MEDLINE, Embase, LILACS, CareSearch, and OpenGrey were searched from inception to 2016. Conference abstracts and reference lists were handsearched, and the lead investigators of included trials and Australian manufacturers were contacted. Included studies were randomized controlled trials evaluating one or more of lidocaine via intravenous or subcutaneous route, or mexiletine, flecainide, or tocainide via oral route; delivered at a site distant to the pain locus. The methodological quality of studies was assessed using the "risk of bias" domain-based evaluation by Jadad. Protocol is available on PROSPERO:CRD42016047092. Results: One positive (n = 50) and three negative (n = 10 each) crossover trials evaluated lidocaine versus placebo, and one trial (n = 16) compared lidocaine with dexmedetomidine. Meta-analysis of pooled data in 60 patients demonstrated a significant benefit of lidocaine infusion of 4-5 mg/kg over 30-80 minutes compared with placebo for >50% reduction in cancer pain. Secondary outcomes did not show a significant difference. Discussion: Based on the current available evidence, lidocaine infusion could be considered in refractory cancer pain where agents with level 1 evidence are ineffective. Further research is necessary to understand the protocol and population in which lidocaine may improve cancer pain and capitalize on the promising opportunities identified.	en_US
dc.relation.ispartof	Journal of Palliative Medicine	en_US
dc.relation.isbasedon	10.1089/jpm.2018.0257	en_US
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject.classification	Gerontology	en_US
dc.title	Lidocaine for Cancer Pain in Adults: A Systematic Review and Meta-Analysis	en_US
dc.type	Journal Article
utslib.citation.volume	3	en_US
utslib.citation.volume	22	en_US
utslib.for	1112 Oncology and Carcinogenesis	en_US
utslib.for	1103 Clinical Sciences	en_US
utslib.for	1110 Nursing	en_US
utslib.for	1117 Public Health and Health Services	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/IMPACCT
pubs.organisational-group	/University of Technology Sydney/Students
utslib.copyright.status	closed_access	*
pubs.issue	3	en_US
pubs.publication-status	Published	en_US
pubs.volume	22	en_US

Abstract:

© 2019, Mary Ann Liebert, Inc. Background: Internationally, use of lidocaine infusions to treat cancer pain varies by center. Existing systematic reviews do not adequately inform use of lidocaine in cancer pain. Objective: To assess the effects of systemic sodium channel blockers on cancer pain in adults, review the dose protocols for administration, and assess toxicity. Design: Databases CENTRAL, MEDLINE, Embase, LILACS, CareSearch, and OpenGrey were searched from inception to 2016. Conference abstracts and reference lists were handsearched, and the lead investigators of included trials and Australian manufacturers were contacted. Included studies were randomized controlled trials evaluating one or more of lidocaine via intravenous or subcutaneous route, or mexiletine, flecainide, or tocainide via oral route; delivered at a site distant to the pain locus. The methodological quality of studies was assessed using the "risk of bias" domain-based evaluation by Jadad. Protocol is available on PROSPERO:CRD42016047092. Results: One positive (n = 50) and three negative (n = 10 each) crossover trials evaluated lidocaine versus placebo, and one trial (n = 16) compared lidocaine with dexmedetomidine. Meta-analysis of pooled data in 60 patients demonstrated a significant benefit of lidocaine infusion of 4-5 mg/kg over 30-80 minutes compared with placebo for >50% reduction in cancer pain. Secondary outcomes did not show a significant difference. Discussion: Based on the current available evidence, lidocaine infusion could be considered in refractory cancer pain where agents with level 1 evidence are ineffective. Further research is necessary to understand the protocol and population in which lidocaine may improve cancer pain and capitalize on the promising opportunities identified.

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http://hdl.handle.net/10453/135486