Jennifer Stahl*, Katayoon Dowlatshahi, Sami Getahun, Hyunjeong Lee and Kori Brewer
Correspondence Address :
Jennifer L Stahl,
Emergency Medicine and Critical Care Medicine
Department of Emergency Medicine Brody School of Medicine
East Carolina University
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.
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