Perioperative Intravenous Lidocaine Infusion Adverse Reaction: A Case Report

Perioperative Intravenous Lidocaine Infusion Adverse Reaction: A Case Report

Intravenous lidocaine is increasingly being utilized as an opioid-sparing analgesic. A 55-year-old man with well-controlled human immunodeficiency virus on highly active antiretroviral therapy was prescribed a lidocaine infusion at 1 mg/kg/h for postoperative pain. On postoperative day 2, the patien...

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Bibliographic Details
Published in:A&A practice Vol. 13; no. 3; pp. 96 - 98
Main Authors: Kramer, MaryJo E., Holtan, Elizabeth E., Ives, Amy L., Wall, Russell T.
Format: Journal Article
Language:English
Published: United States International Anesthesia Research Society 01-08-2019
Subjects:
Anesthetics - adverse effects
Anesthetics - blood
Anesthetics - pharmacokinetics
Anti-HIV Agents - pharmacokinetics
Anti-HIV Agents - therapeutic use
Antiretroviral Therapy, Highly Active
HIV Infections - drug therapy
Humans
Infusions, Intravenous
Lidocaine - adverse effects
Lidocaine - blood
Lidocaine - pharmacokinetics
Male
Middle Aged
Pain, Postoperative - drug therapy
Perioperative Period
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Summary:Intravenous lidocaine is increasingly being utilized as an opioid-sparing analgesic. A 55-year-old man with well-controlled human immunodeficiency virus on highly active antiretroviral therapy was prescribed a lidocaine infusion at 1 mg/kg/h for postoperative pain. On postoperative day 2, the patient experienced 4 unresponsive episodes with tachycardia, hypertension, and oxygen desaturation. Serum lidocaine level was available 2 days later (high 6.3 µg/mL, therapeutic range 2.5–3.5 µg/mL). There is significant pharmacokinetic interaction between lidocaine and this patient’s human immunodeficiency virus medications. This case highlights the need for a readily accessible list of medications that caution against lidocaine. We propose in-house serum lidocaine levels to monitor patients at an increased risk for toxicity.
ISSN:2575-3126
2575-3126
DOI:10.1213/XAA.0000000000001002