Comparing intravenous lidocaine and pethidine for pain management in emergency department patients with femoral bone fracture: a randomized controlled trial

BMC Anesthesiol. 2024 Jul 23;24(1):250. doi: 10.1186/s12871-024-02640-4.

Abstract

Background: Intravenous lidocaine has shown promise as an effective analgesic in various clinical settings, but its utility for pain management in emergency departments, especially for bone fractures, remains relatively understudied.

Objective: This study compared intravenous lidocaine to pethidine for femoral bone fracture pain management.

Methods: This double-blind, randomized, controlled clinical trial was conducted in the emergency department of AJA University of Medical Sciences affiliated hospitals. Patients aged 18-70 years-old with femoral bone fracture and experiencing severe pain, defined as a numerical rating scale (NRS) of pain ≥ 7, were included in the study. One group received intravenous pethidine (25 mg), while the other group received intravenous lidocaine (3 mg/kg, not exceeding 200 mg), infused with 250 ml saline over 20 min. Pain levels were evaluated before treatment administration (0 min) and at 10, 20, 30, 40, 50, and 60 min after treatment administration using the NRS.

Results: Seventy-two patients were enrolled in the study. Demographic characteristics and pain scores were similar between the two groups. The mean pain scores upon arrival for the lidocaine and pethidine groups were 8.50 ± 1 and 8.0 ± 1, respectively; after one hour, they were 4.0 ± 1 and 4.0 ± 1, respectively. While there was a statistically significant reduction in pain in both groups after one hour, there were no clinically or statistically significant differences between the two groups (p = 0.262). Pethidine had a higher incidence of adverse events, though not statistically significant. Additionally, females required more rescue analgesics.

Conclusion: The administration of intravenous lidocaine is beneficial for managing pain in femoral bone fractures, suggesting that lidocaine could be a potent alternative to opioids.

Trial registration: IRCT20231213060355N1 ( https://irct.behdasht.gov.ir/trial/74624 ) (30/12/2023).

Keywords: Emergency department; Femoral bone fracture; Intravenous lidocaine; Pain management; Pethidine.

Publication types

  • Randomized Controlled Trial
  • Comparative Study

MeSH terms

  • Administration, Intravenous
  • Adolescent
  • Adult
  • Aged
  • Analgesics, Opioid* / administration & dosage
  • Analgesics, Opioid* / therapeutic use
  • Anesthetics, Local* / administration & dosage
  • Double-Blind Method
  • Emergency Service, Hospital*
  • Female
  • Femoral Fractures* / complications
  • Humans
  • Lidocaine* / administration & dosage
  • Male
  • Meperidine* / administration & dosage
  • Middle Aged
  • Pain Management* / methods
  • Pain Measurement / methods
  • Young Adult

Substances

  • Lidocaine
  • Meperidine
  • Anesthetics, Local
  • Analgesics, Opioid