Continuous Subcutaneous Lidocaine for Pain Management
The purpose of this booklet is to explain about treating your pain with continuous subcutaneous lidocaine and how to care for your infusion at home. If you have any other questions please be sure to ask your doctor or nurse.
Why do I need this?
In certain types of pain, it has been found that the pain is caused either by nerves that are injured or nerves that are not working right. This is called "neuropathic" pain. Besides hurting, this kind of pain may also feel like "pins and needles", "burning", "stiffness", "numbness" or "tingling". It has been found that lidocaine can be very useful in easing this type of pain. This medicine does not come in the form of a pill, so it is given through a very small needle under the skin.
Are there any side effects?
Yes, like most medicines, lidocaine may have side effects. Side effects can be mild, moderate or severe. You need to know that side effects are related to the level of lidocaine in your bloodstream. This is called the "serum" level. If side effects develop, we may check your serum level.
Risk of severe side effects is low when your serum level is below 6mcg/mL. During the start of your treatment, the nurse will be checking you often and asking you if you have any side effects. You must know what side effects might happen and report them at any time. If you have these side effects, the dose of your medicine may need to be changed. You should report:
Mild side effects
(at serum levels 3-8 mcg/mL)
- numbness and tingling in the fingers and toes
- numbness or tingling around your mouth
- a metallic taste in your mouth
- ringing in the ears
- feeling lightheaded or dizzy
Moderate side effects
(at serum levels 8-12 mcg/mL)
- nausea and vomiting
- severe dizziness
- decreased hearing
- tremors (feeling shaky)
- changes in blood pressure and pulse
Severe side effects
(at serum levels >12 mcg/mL)
- feeling drowsy
- confusion
- muscle twitching
- seizures
- loss of consciousness
- serious heart problems
If you have any of these side effects, turn off the infusion and make sure to have your lidocaine level drawn. Remember that the mild side effects will occur first and are an early warning of lidocaine toxicity. It is very important to pay attention to the mild and moderate side effects listed above.
Most of the time, the side effects will be gone within 30 minutes to an hour after stopping the infusion, but you may have to wait longer for them to subside. We suggest that when you restart the lidocaine, the dose should be reduced by 20%.
How can I help?
- Use a pain scale to describe your pain. For example, on a scale of 0 to 10, with 0 being no pain, and 10 being the worst pain you can imagine, how much pain do you have right now?
- Know what side effects might happen and report them to your nurse and doctor. When home, be prepared to have your lidocaine level drawn if needed.
- Talk with your doctors and nurses about any concerns or fears you may have about pain and its treatment.
- Tell us what you are taking for other health problems. We need to know because mixing some drugs with pain medicines can cause problems.
- Take an active role in learning how to use this treatment at home.
How long will I use this treatment?
This treatment is started in the hospital. It can take about 2-3 days to find the right dose that will relieve your pain. The total length of time you will be treated with this medicine depends on how well it works to control your pain. Most patients will receive this treatment for at least a few months.
How do I manage this treatment at home?
Before you go home, a nurse from a home infusion company will meet with you to bring equipment and medicine for you to use at home. The nurse will also explain how to care for the pump and needle site at home and how to arrange for serum levels to be drawn when needed.
Who do I call for questions or concerns?
Home Infusion Company:____________________________________________
Other:____________________________________________________________
Directions for needle site changes
Using the Sof-Set ®
The Sof-set® is a small needle used in the continuous subcutaneous administration of medicine. This means that the needle will go just below the surface of the skin. If you are using Sof-set for the first time, we suggest that you do your first set-up in the presence of your doctor or nurse.
Directions:
1. Wash your hands.
2. Gather all the needed supplies and place them on a clean table.
- infusion pump with bag of lidocaine
- new pump tubing
- Sof-set ®
- one alcohol prep swab
- roll of paper tape
- needle discard box
3. Connect the Sof-set® to the pump tubing. Then connect the entire tubing set-up to the medicine bag.
4. Fill the tubing and Sof-set® with medicine from the pump (as shown in the pump booklet), until the entire set-up appears full.
5. Tear off several 2 inch pieces of the paper tape and put them where you can reach them when you need them.
6. Select an insertion site for the Sof-set cannula. Any area with a layer of fat can be used. Most people rotate sites around the front of their chest and stomach (see drawing).
7. Open up the alcohol swab and clean the site you are going to use, going in circles from the center outward, for at least 30 seconds.
8. Remove the Sof-set® from its plastic guard by firmly gripping the wing and sliding it out. Caution: Do not pull on Sof-set tubing to remove it from the package.
9. Lift the white tab to remove the adhesive backing and peel it off.
10. Check to be sure the point of the needle is beyond the end of the soft cannula. If it is not, advance the needle by pushing the needle hub until you can see the end of the needle (see drawing below).
11. Hold the wings on each side with your thumb and middle finger. Use your index finger to keep the top of the plastic needle hub steady. Flex the wing up as show in drawing below.
12. Pinch the fatty tissue as you would to give yourself a shot. While holding the plastic needle hub, insert the needle at a 90 angle straight into the skin and tissue.
13. Check to be sure that the cannula goes all the way into the tissue (see drawing below).
14. Hold the Sof-set® in place and withdraw the needle (see drawing below). Be sure not to pull the entire Sof-set out of the skin. Never put the needle back into the Sof-set®. This could cause tearing of the cannula and the lidocaine might not flow as it should.
15. Tape the Sof-set® in place using the paper tape. We suggest that you do not use the white bandage that comes with the Sof-set to protect your skin.
16. Make a loose loop of tubing and anchor with tape to avoid tension on the site.
17. Throw away the needle in your needle discard box.
18. Restart the infusion as you have been shown.
The needle site should be changed about every 48 to 72 hours or sooner if it becomes red or looks like it is leaking. If the infusion is running at 3 ml or more per hour, you may need to use two different sites.
UWHC Nursing Policy #10.18. Continuous Subcutaneous Lidocaine Infusion
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 08/09/2011
Copyright © 08/09/2011 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5314
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