Is there evidence to support applying lidocaine (local anesthetic) patches for more than 12 hours a day?

Lidocaine Patches Should Not Be Applied for More Than 12 Hours Per Day

There is no evidence supporting the application of lidocaine patches for more than 12 hours per day, and the standard recommendation is to apply patches for 12 hours followed by a 12-hour removal period to allow skin recovery and minimize risks. 1

Evidence for Standard Application Duration

The current evidence-based practice for lidocaine patch application follows a specific schedule:

• Standard duration is 12 hours on, followed by 12 hours off 1
• This schedule provides:
  • Effective pain relief
  • Allows skin recovery
  • Minimizes risk of cumulative lidocaine absorption
  • Reduces potential for skin irritation

Safety Considerations

Several safety factors support limiting application to 12 hours:

• The FDA-approved lidocaine patch labeling does not support continuous 24-hour application 2
• Pharmacokinetic studies show that while continuous application for 72 hours (changing patches every 12 or 24 hours) produces plasma lidocaine concentrations below toxic levels, this usage pattern has not been approved for clinical practice 3
• Topical lidocaine patches should be removed before starting intravenous lidocaine infusions due to potential cumulative effects 4
• Continuous application may increase the risk of:
  • Local skin reactions
  • Cumulative systemic absorption
  • Potential for sensitization

Clinical Applications and Alternatives

For patients requiring pain management:

1. Apply lidocaine patches directly to the most painful area 1
2. Follow the standard 12-hour application/12-hour removal schedule
3. Consider alternatives if 12-hour coverage is insufficient:
   • Multiple patch application sites (within recommended limits)
   • Combination with other analgesic modalities
   • Alternative topical agents (e.g., NSAIDs, capsaicin)

Common Pitfalls to Avoid

• Exceeding recommended application duration in an attempt to improve efficacy
• Applying multiple patches beyond recommended limits
• Failing to remove patches before initiating intravenous lidocaine therapy
• Overlooking skin irritation that may develop with prolonged application

While pharmacokinetic studies suggest safety with continuous application under controlled conditions 3, clinical guidelines consistently recommend the 12-hour on/12-hour off schedule to balance efficacy with safety concerns 1. This approach has demonstrated effectiveness for various pain conditions including postherpetic neuralgia 5, 6 while maintaining an excellent safety profile comparable to placebo 7.