Key result
Intravenous lidocaine reduced ICP in all 3 therapeutic studies, while prophylactic pretreatment attenuated ICP spikes during stimulation in 4 of 7 studies.
Why the study?
Does intravenous lidocaine reduce or attenuate intracranial pressure in patients with neurological illness?
Systematic Review (n=189)
Does intravenous lidocaine reduce or attenuate intracranial pressure in patients with neurological illness?
IV lidocaine shows potential for reducing ICP when used therapeutically, but evidence for prophylactic attenuation of ICP spikes during stimulation is mixed.
Answers are grounded in this paper and cite their sources.
May support therapeutic IV lidocaine for ICP reduction; extends sparse data but leaves prophylactic role unresolved.
Background. The goal of our study was to perform a systematic review of the literature to determine the effect that intravenous (IV) lidocaine had on ICP in patients with neurological illness. Methods. All articles are from MEDLINE, BIOSIS, EMBASE, Global Health, Scopus, Cochrane Library, the International Clinical Trials Registry Platform (inception to March 2015). The strength of evidence was adjudicated using both the Oxford and GRADE methodology. Results. Ten original articles were considered for the final review. There were 189 patients studied. Seven studies focused on prophylactic pretreatment with IV lidocaine to determine if there would be an attenuation of ICP spikes during stimulation, with 4 displaying an attenuation of ICP. Three studies focused on a therapeutic administration of IV lidocaine in order to determine ICP reduction effects. All therapeutic studies displayed a reduction in ICP. Conclusions. We cannot make a strong definitive recommendation on the effectiveness of IV lidocaine on the attenuation of ICP spikes during stimulation. There currently exists both Oxford 2b and GRADE B literature to support and refute the attenuation of ICP spikes with IV lidocaine during stimulation. There currently exists Oxford 2b, GRADE B evidence to support ICP reduction with lidocaine when used as a therapeutic agent.
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Zeiler et al. (2015) conducted a systematic review in Neurological illness (n=189). Intravenous lidocaine was evaluated on Effect on intracranial pressure (attenuation of spikes or reduction). Intravenous lidocaine reduced ICP in all 3 therapeutic studies, while prophylactic pretreatment attenuated ICP spikes during stimulation in 4 of 7 studies.
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