Duration of Intravenous Lidocaine Infusion for Postoperative Pain Management

Standard Duration Protocol

The maximum initial duration of intravenous lidocaine infusion for postoperative pain management should not exceed 24 hours for most patients, as postoperative pain decreases with time and other analgesics remain available 1, 2, 3, 4
Most patients do not benefit from prolonged infusion beyond 24 hours, though exceptions exist for patients with chronic pain 1, 2, 3, 4

If extending the infusion beyond 24 hours becomes necessary, the decision must be made by a consultant anaesthetist or intensivist and/or the acute pain team, within the scope of relevant hospital guidelines 1, 2, 4
When extending the infusion beyond 24 hours, the infusion rate must be reduced to 50% of the original rate 1, 2, 4
Lidocaine exhibits time-dependent pharmacokinetics after 12 hours of infusion, with the elimination half-life prolonging from approximately 100 minutes to 3.22 hours after 24 hours 5

Lidocaine pharmacokinetics are linear and predictable only up to 12 hours of continuous infusion 5

Lipid emulsion 20% must be readily available wherever IV lidocaine is used throughout the infusion duration 1, 2, 4, 6
Patients should ideally be managed in a monitored bedspace (high dependency unit/level 2 care) outside the operating theatre/recovery room 1, 4
Monitoring frequency should be every 15 minutes for the first hour, then hourly as minimum thereafter 1, 4
Early signs of toxicity include peri-oral tingling, tinnitus, light-headedness, and restlessness—these neurological symptoms appear before cardiovascular changes 1, 4