From the Guidelines
Intravenous (IV) lidocaine is not recommended for the management of stroke and has no established role in standard stroke treatment protocols. The primary treatments for ischemic stroke include IV thrombolytics such as alteplase (tPA) administered within 4.5 hours of symptom onset, and mechanical thrombectomy for eligible patients with large vessel occlusions. For hemorrhagic stroke, management focuses on blood pressure control, reversal of anticoagulation if applicable, and sometimes surgical intervention. While lidocaine is commonly used as a local anesthetic and antiarrhythmic agent, it has not demonstrated benefit in stroke outcomes and could potentially cause adverse effects including central nervous system toxicity and cardiovascular complications if administered inappropriately. Some research has explored lidocaine's potential neuroprotective properties through sodium channel blockade and anti-inflammatory effects, but these remain experimental and have not translated to clinical practice.
Key Points
- The 2018 guidelines for the early management of patients with acute ischemic stroke from the American Heart Association/American Stroke Association 1 provide comprehensive recommendations for clinicians caring for adult patients with acute arterial ischemic stroke.
- These guidelines address prehospital care, urgent and emergency evaluation and treatment with intravenous (IV) and intra-arterial therapies, and in-hospital management, including secondary prevention measures that are often begun during the initial hospitalization.
- The guidelines do not mention IV lidocaine as a treatment option for stroke, highlighting its lack of established role in standard stroke treatment protocols.
- Clinicians should adhere to evidence-based stroke management guidelines which currently do not include IV lidocaine as a treatment option, prioritizing treatments with proven benefits for morbidity, mortality, and quality of life, such as IV thrombolytics and mechanical thrombectomy for eligible patients.
Considerations
- The potential risks associated with IV lidocaine, including central nervous system toxicity and cardiovascular complications, further support its exclusion from standard stroke treatment protocols.
- The focus of stroke management should remain on evidence-based treatments that have demonstrated improvements in patient outcomes, such as IV thrombolytics and mechanical thrombectomy, rather than experimental or unproven therapies like IV lidocaine.
From the Research
Role of IV Lidocaine in Stroke Management
- IV lidocaine has been explored for various medical conditions, but its role in stroke management is not widely established as a primary treatment.
- A study from 2 discusses the use of IV lidocaine infusion for relief of central pain after a stroke, indicating some potential benefits in post-stroke pain management.
- However, there is limited direct evidence supporting the use of IV lidocaine as a primary treatment for stroke itself.
- Other studies, such as 3, highlight the risks of lidocaine toxicity, which can manifest as neurologic dysfunction similar to a stroke, emphasizing the need for careful consideration and monitoring if lidocaine is used in the context of stroke or related conditions.
- The management of stroke typically involves other treatments, such as intravenous tissue plasminogen activator (t-PA) and endovascular treatment, as discussed in 4, with no mention of IV lidocaine as a standard therapy.
- Lidocaine has been used in other neurological conditions, like convulsive status epilepticus 5, and as an adjunctive therapy in decompression illness 6, but these uses do not directly relate to its application in stroke management.