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Journal of General and Emergency Medicine

JGEM

Aabstract

Research Article

Efficacy of Lidocaine 4 Transdermal Patch in Acute Musculoskeletal Pain in the Emergency Department: A Randomized Pilot Study

Jennifer Stahl*, Katayoon Dowlatshahi, Sami Getahun, Hyunjeong Lee and Kori Brewer

Correspondence Address :

Jennifer L Stahl,
Assistant Professor
Emergency Medicine and Critical Care Medicine
Department of Emergency Medicine Brody School of Medicine
East Carolina University
Greenville, NC

Received on: May 02, 2022, Accepted on: May 13, 2022, Published on: May 17, 2022

Citation: Jennifer Stahl, Katayoon Dowlatshahi, Sami Getahun, Hyunjeong Lee, Kori Brewer (2022). Efficacy of Lidocaine 4% Transdermal Patch in Acute Musculoskeletal Pain in the Emergency Department: A Randomized Pilot Study

Copyright: © 2022 Jennifer L Stahl. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

  • Abstract

Abstract

Objective: To evaluate the efficacy of transdermal lidocaine and ibuprofen versus ibuprofen alone in Emergency Department (ED) patients with acute musculoskeletal pain.
Setting: This pilot study was performed at a single tertiary center ED
Participants: Patients with a chief complaint of acute, isolated musculoskeletal pain (≤7 days duration) were screened for participation. Inclusion criteria included age ≥ 18 years, English speaking, and no prior ED visits for the chief complaint. Exclusion criteria included pregnant/breastfeeding patients, open wounds over pain area, end-stage renal disease, diabetes, and medications such as opiates, muscle relaxants, or ibuprofen prior to enrollment.
Intervention: Patients were randomized to two treatment arms: (1) ibuprofen or (2) transdermal lidocaine patch and ibuprofen.
Primary and Secondary Outcomes: Patient reported pain at one hour from medication administration was the primary outcome of this study. Secondary outcomes included baseline pain level and change in pain score from baseline.
Results: Data analysis from 17 patients showed a decrease in average pain scores by 2 points in the control group (± 2.8) compared to 1.6 points (± 0.9) in the lidocaine patch group (p=0.17). While there was no clinically significant difference in mean pain scores between the control group and the lidocaine patch group at baseline (6.7 ± 1.9 vs. 7.4 ± 1.9; p=0.46) or at one hour (4.1 ± 2.9 vs. 5.6 ± 1.9; p=0.26), there was less variability evidenced by a tighter 95% confidence interval in the lidocaine patch group.
Conclusion: While the lidocaine patch plus ibuprofen group did not show a statistically significant improvement in pain score when compared to ibuprofen alone, there was a less variable reduction in pain possibly indicating more consistent pain reduction. Further investigation with a larger multicenter trial should be performed to evaluate the efficacy of transdermal lidocaine as an adjunctive treatment for acute musculoskeletal pain.
Strengths and Limitations
• Patients were prospectively randomized into two treatment groups to compare
ibuprofen vs ibuprofen plus transdermal lidocaine
• Pain scores were obtained to evaluate subjective pain symptoms of patients at
baseline and at one hour from medication administration
• Sample size of this pilot trial was small
Keywords: NSAID, Ibuprofen, Transdermal lidocaine, Acute pain, Musculoskeletal pain, Emergency Department

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