From the Research
IV lidocaine is not recommended for stroke treatment in patients who were not thrombolysed and are more than 24 hours from symptom onset. There is insufficient clinical evidence supporting its efficacy in this specific patient population. The established treatments for acute ischemic stroke focus on reperfusion therapies like IV thrombolysis with alteplase within 4.5 hours of symptom onset or mechanical thrombectomy within 24 hours for eligible patients with large vessel occlusions, as seen in studies such as 1, which demonstrated the benefits of alteplase in patients with posterior circulation ischemic stroke at 4.5 to 24 hours. For patients beyond the 24-hour window, treatment typically shifts to secondary prevention strategies including antiplatelet therapy, statins, blood pressure management, and rehabilitation. While lidocaine has local anesthetic properties and can block sodium channels which might theoretically provide neuroprotection by reducing excitotoxicity, clinical trials have not demonstrated meaningful benefit in post-acute stroke care. Additionally, IV lidocaine carries risks including cardiac arrhythmias, hypotension, and central nervous system toxicity. Current stroke management guidelines do not include IV lidocaine as a recommended intervention for patients in the subacute or chronic phases of stroke recovery.
Some studies, such as 2, have explored the use of lidocaine for poststroke pain, but these findings do not support its use for stroke treatment in the context provided. Other studies, like 3, 4, and 5, discuss various aspects of stroke treatment and thrombolysis but do not provide evidence for the use of IV lidocaine in patients who were not thrombolysed and are more than 24 hours from symptom onset. Therefore, based on the lack of evidence and potential risks, IV lidocaine should not be used for stroke treatment in this patient population.