Lidocaine Lidocaine (Parenteral)

INTRODUCTION

Indications

IV: Ventricular arrhythmias. IM: Self-injected or when IV unavailable (during transport to hospital facilities). Local: Infiltration/mucosal/topical anesthetic. Patch: Pain due to postherpetic neuralgia.

Action

IV, IM: Suppresses automaticity and spontaneous depolarization of the ventricles during diastole by altering the flux of sodium ions across cell membranes with little or no effect on heart rate. Local: Produces local anesthesia by inhibiting transport of ions across neuronal membranes, thereby preventing initiation and conduction of normal nerve impulses. Therapeutic Effects: Control of ventricular arrhythmias. Local anesthesia.

Adverse Reactions/Side Effects

Applies mainly to systemic use

CNS: SEIZURES, confusion, drowsiness, blurred vision, dizziness, nervousness, slurred speech, tremor. EENT: mucosal use—decreased or absent gag reflex. CV: CARDIAC ARREST, arrhythmias, bradycardia, heart block, hypotension. GI: nausea, vomiting. Resp: bronchospasm. Local: stinging, burning, contact dermatitis, erythema. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for new seizures or increased seizure activity, especially during IV or IM administration. Document the number, duration, and severity of seizures, and report these findings immediately to the physician.

• Monitor cardiac symptoms at rest and during exercise. Seek immediate medical assistance if symptoms of cardiac arrest develop, including sudden chest pain, pain radiating into the arm or jaw, shortness of breath, dizziness, sweating, anxiety, and nausea.

• Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms (laryngeal edema, bronchospasm, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Although intended to treat certain arrhythmias, this drug can unmask or precipitate new arrhythmias (proarrhythmic effect). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest pain, shortness of breath, fainting, and fatigue/weakness.

• Be alert for other signs of toxicity during continuous systemic administration or prolonged use of lidocaine patches. Signs of toxicity include confusion, nervousness, tremor, blurred or double vision, nausea, vomiting, slurred speech, ringing in ears, tremors, twitching, difficulty breathing, severe dizziness or fainting, and unusually slow heart rate. Report these signs to physician or nursing staff immediately.

• When used for regional pain control or neuropathic pain, use appropriate pain scales and sensory testing to document level of local anesthesia and analgesic effects.

• Assess dizziness and drowsiness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician ...