Intravenous Lidocaine Versus Morphine for Severe Pain in the ED

Phase 4

Completed

Conditions: Pain

Interventions: Drug: Intravenous lidocaine
Drug: Intravenous morphine

Registration Number: NCT02912195

Lead Sponsor: Alameda Health System

Brief Summary: Objective: Evaluate the analgesic efficacy of intravenous (IV) lidocaine versus provider chosen dose of IV morphine for the treatment of severe pain in the emergency department.

Study design: Open-label, randomized controlled pilot study.

Detailed Description: Objective: The purpose of this pilot study is to determine the analgesic efficacy of intravenous lidocaine versus morphine for the treatment of severe pain in the emergency department (ED).

Study design: Open-label, randomized, controlled pilot trial. Participants: Investigators and research assistants will recruit patients ≥18 years old with severe pain (NRS ≥7) and an anticipated stay in the emergency department ≥1 hour. A sample size calculation was performed and 32 patients will be enrolled.

Intervention: After a trained research assistant obtains written informed consent, eligible participants will be randomized to the intravenous lidocaine or morphine arms of the study. In the intravenous lidocaine arm, patients will receive IV lidocaine (75 mg if \<50kg, 100 mg if 50 - 100 kg, and 150 mg if \>100 kg) over 10 minutes in a 100 mL normal saline minibag followed by a 50 minute IV lidocaine drip (75 mg if \<50kg, 100 mg if 50 - 100 kg, and 150 mg if \>100 kg). In the morphine arm, the ED provider will choose an appropriate dose of morphine for the patient. At 20 and 40 minutes, the participants will be asked "Would you like additional pain medication?". Participants responding in the affirmative will receive morphine 4 mg IV.

Data collection: The trained research assistant will collect data on the patients' pain scores, side effects, and rescue morphine.

Statistical analysis: Investigators will perform descriptive statistics and compare pain scores and pain relief at each time point with unpaired t-tests.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 32

Inclusion Criteria

Subject has severe pain (NRS ≥7)
Subject has anticipated ED stay of ≥1 hour

Exclusion Criteria

High acuity trauma patients
Patients deemed to critically ill by ED provider
Active psychosis
Pregnancy
History of heart block or bradycardia
Allergy to lidocaine or amide type local anesthetic
History of seizures

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Intravenous lidocaine	Intravenous lidocaine	Participants will receive IV lidocaine (75 mg if \<50kg, 100 mg if 50 - 100 kg, and 150 mg if \>100 kg) over 10 minutes in a 100 mL normal saline minibag followed by a 50 minute IV lidocaine drip (75 mg if \<50kg, 100 mg if 50 - 100 kg, and 150 mg if \>100 kg) in a 100 mL normal saline minibag. At 20 and 40 minutes, participants can elect to receive morphine 4mg IV as a rescue analgesic.
Morphine	Intravenous morphine	ED provider will choose an appropriate dose of intravenous morphine for the patient. At 20 and 40 minutes, participants can elect to receive morphine 4mg IV as a rescue analgesic.

Primary Outcome Measures

Name	Time	Method
Pain Score (NRS 0-10)	At 60 minutes	Pain score is rated on the Numeric Rating Scale from 0-10. 0 represents no pain and 10 represents the worst possible pain.

Secondary Outcome Measures

Name	Time	Method
Pain Relief at 40 Minutes Compared to Baseline.	At 40 minutes	Pain numeric rating scale (NRS) at 0 minutes minus pain NRS at 40 minutes. NRS is a scale ranging from 0, no pain, to 10 worst pain.
Number of Participants Requiring Rescue Medications	At 20 and 40 minutes	The percentage of patients requiring rescue IV morphine at 20 and 40 minutes
Pain Relief at 10 Minutes Compared to Baseline.	At 10 minutes	Pain NRS at 0 minutes minus pain NRS at 10 minutes
Pain Relief at 20 Minutes Compared to Baseline.	at 20 minutes	Pain numeric rating scale (NRS) at 0 minutes minus pain NRS at 20 minutes. NRS is a scale ranging from 0, no pain, to 10 worst pain.
Pain Relief at 50 Minutes Compared to Baseline.	At 50 minutes	Pain numeric rating scale (NRS) at 0 minutes minus pain NRS at 50 minutes. NRS is a scale ranging from 0, no pain, to 10 worst pain.
Pain Score (NRS 0-10)	At 50 minutes	Pain score recorded on the numeric rating scale 0-10.
Pain Relief at 60 Minutes Compared to Baseline.	At 60 minutes	Pain numeric rating scale (NRS) at 0 minutes minus pain NRS at 60 minutes. NRS is a scale ranging from 0, no pain, to 10 worst pain.
Pain Relief at 30 Minutes Compared to Baseline.	at 30 minutes	Pain numeric rating scale (NRS) at 0 minutes minus pain NRS at 30 minutes NRS is a scale ranging from 0, no pain, to 10 worst pain.
Patient Satisfaction	60 minutes	The proportion of patients saying, "Yes" to "Would you have this pain medication again for similar pain?"
Number of Participants Reporting Adverse Events	0-60 minutes	Participants will be observed for the following adverse events and side effects: seizure, bradyarrhythmias, hyper or hypotension, perioral numbness, tinnitus, metallic taste, other, hypotension, hypoxia, nausea, vomiting, itching, or other side effects. Participants have the opportunity to report other side effects during the study

Trial Locations

Locations (1): Alameda Health System, Highland Hospital
🇺🇸
Oakland, California, United States
Alameda Health System, Highland Hospital
🇺🇸Oakland, California, United States