From the Guidelines
Lidocaine is not used to prevent reaccumulation of pericardial effusion. According to the 2015 ESC guidelines for the diagnosis and management of pericardial diseases 1, therapy of pericardial effusion should be targeted at the etiology as much as possible. The guidelines suggest that when a pericardial effusion becomes symptomatic without evidence of inflammation or when empiric anti-inflammatory drugs are not successful, drainage of the effusion should be considered. Pericardiocentesis with prolonged pericardial drainage may be considered to promote adherence of pericardial layers and prevent further accumulation of fluid. However, there are no proven effective medical therapies to reduce an isolated effusion, and lidocaine is not mentioned as a treatment option for preventing reaccumulation of pericardial effusion.
Some key points to consider in the management of pericardial effusion include:
- Identifying and treating the underlying cause of the effusion
- Using anti-inflammatory medications such as colchicine, NSAIDs, or corticosteroids depending on the underlying cause
- Considering pericardiocentesis or more invasive approaches such as pericardial window creation or pericardiectomy for recurrent or persistent effusions
- Targeted therapies for conditions like tuberculosis, hypothyroidism, or rheumatologic disorders that can cause pericardial fluid accumulation.
The guidelines emphasize the importance of individualized treatment based on the specific etiology of the effusion, and lidocaine is not a recommended treatment for preventing reaccumulation of pericardial effusion 1.
From the Research
Use of Lidocaine in Preventing Reaccumulation of Pericardial Effusion
- Lidocaine is used in the management of pericardial effusion, particularly in the context of malignant pericardial effusion 2.
- In a study published in 1987, lidocaine hydrochloride was instilled intrapericardially, followed by tetracycline hydrochloride, to manage malignant pericardial effusion 2.
- The use of lidocaine in this context is aimed at preventing reaccumulation of pericardial fluid, although the primary agent for sclerosis is tetracycline 2.
- Other methods for preventing reaccumulation of pericardial fluid include intrapericardial injection of sclerosing agents, surgical pericardiotomy, and percutaneous balloon pericardial window creation 3.
- The selection of the pericardial drainage procedure depends on the etiology of the effusion, with simple pericardiocentesis usually sufficient in patients with acute idiopathic or viral pericarditis, and more invasive procedures reserved for cases with malignant or purulent pericarditis 4.