Take Home: Lidocaine IV seems like a reasonable, “non-opiate” alternative therapy for patients with reasons to not want to provide opiates. (high opiate tolerance, pregnancy (category B), or suspected abuse). It is just one study, but an interesting alternative I will use.
Effectiveness of intravenous lidocaine versus intravenous morphine for patients with renal colic in the emergency department
– BMC Urology 2012
Design: Prospective Randomized Double Blind trial
Population: Healthy 18-65 year olds who presented to the ED with clinical renal colic
- EKG obtained and normal
- No history of heart disease
Intervention/Control: Randomized to EITHER:
- Lidocaine 1.5mg/kg IV (slow IV push)
- Morphine 0.1 mg/kg IV (slow IV push)
Primary Outcome: VAS Pain score was measured at Time 0,5,10,15, and 30
Secondary Outcomes: Side Effects of medications
Results: 240 patients were randomized.
Lidocaine is group I, Morphine is group II
90% of patients responded to Lidocaine vs 70% in Morphine group.
Is the difference between 1.13 and 2.23 really clinically significant – unsure, BUT the data suggests it is at least as effective at pain reduction as morphine.
Conclusion: Lidocaine is a safe and effective therapy for Renal Colic in patients without heart disease.