Early success with use of transdermal lidocaine as primary patch analgesia after joint replacement
Posted March 25,2011
Preliminary results from a study currently underway suggest that use of a transdermal lidocaine 5% patch may reduce the overall use of oral analgesics, including opioids, following knee replacement surgery. This early finding in a randomized, double-blinded, placebo-controlled study led by Arash Nafissi, DO, of New York University Hospital for Joint Diseases in New York City, is promising. While oral opioids are appropriately and effectively used to manage post-operative and rehabilitation pain in older orthopedic patients, avoiding associated adverse effects is desirable when possible. Currently, lidocaine is only indicated for use in postherpetic neuralgia, although topical lidocaine 5% is frequently used off-label in postoperative patients. The research team have designed the study to examine whether the lidocaine patch, when cut in half and placed on both sides of the incision, affects the recovery time, pain levels and opioid use in the study subjects.
Perhaps surprisingly, outcomes have thus far been favorable. One may think of lidocaine as an analgesic for more superficial pain, but an initial look at the first 16 of the 70 patient subjects revealed positive outcomes in the three areas measured. In comparison with the placebo group, those patients who received the lidocaine patch reported less pain overall. Additionally, the patients required less daily acetaminophen and oxycodone, a trend which continued over an average 7-day period. These patients also demonstrated faster improvements in their knee function as measured by the extent of active knee flexion. These preliminary results were presented by poster at the American Academy of Pain Management’s 21st Annual Clinical Meeting in September of 2010. Final results of this particular study are expected later this spring.
These early findings about an alternate use for transdermal lidocaine may hold promise for future older adults undergoing orthopedic procedures, as they may reduce the need for opioids postoperatively and during rehabilitation. The course of treatment in the study was 7 days, making the findings of interest to nursing home clinicians caring for post-operative orthopedic patients.