A single infusion of intravenous lidocaine for primary headaches and trigeminal neuralgia: a retrospective analysis.

Introduction: Intravenous (IV) lidocaine has been used as a transitional treatment in headache and facial pain conditions, typically as an inpatient infusion over several days, which is costly and may increase the risk of adverse effects. Here we report on our experience using a single one-hour IV lidocaine infusion in an outpatient day-case setting for the management of refractory primary headache disorders with facial pain and trigeminal neuralgia. Methods: This is a retrospective, single-center analysis on patients with medically refractory headache with facial pain and trigeminal neuralgia who were treated with IV lidocaine between March 2018 and July 2022. Lidocaine 5 mg.kg-1 in 60 mL saline was administered over 1 h, followed by an observation period of 30 min. Patients were considered responders if they reported reduction in pain intensity and/or headache frequency of 50% or greater. Duration of response was defined as short-term (< 2 weeks), medium-term (2-4 weeks) and long-term (> 4 weeks). Results: Forty infusions were administered to 15 patients with trigeminal autonomic cephalalgias (n = 9), chronic migraine (n = 3) and trigeminal neuralgia (n = 3). Twelve patients were considered responders (80%), eight of whom were complete responders (100% pain freedom). The average duration of the treatment effect for each participant was 9.5 weeks (range 1-22 weeks). Six out of 15 patients reported mild and self-limiting side effects (40%). Conclusion: A single infusion of IV lidocaine might be an effective and safe transitional treatment in refractory headache conditions with facial pain and trigeminal neuralgia. The sustained effect of repeated treatment cycles in some patients may suggest a role as long-term preventive therapy in some patients.

Activities of a Medical Emergency Team: a prospective observational study of 795 calls.

Relatively few papers have examined specific causes for Medical Emergency Team (MET) review and the assessment and management undertaken by the MET. The aim of our study was to describe the type of patients who require MET review, the reasons such reviews are requested and the subsequent immediate management of these patients. Our prospective single-centre observational study was conducted in a university-affiliated tertiary hospital in New Zealand between October 2012 and September 2013. Each trigger for MET review was assessed separately to allow analysis of the main associated underlying conditions and interventions. Seven hundred and ninety-five MET calls were generated for 630 patients. Mean patient age was 64 years. Sixty percent of all calls involved medical patients. There was a marked diurnal variation in the incidence of MET calls, with MET calls more likely during the daytime and evening compared to the night. The most common triggers for MET calls were an unresponsive or fitting patient (25.2%), tachycardia (24.2%), and an Early Warning Score of 8 or more (22.8%). Neurological causes (30.7%), cardiovascular failure (hypotension, pulmonary oedema) (26.7%), respiratory failure (22.6%), and sepsis (19.2%) were the most common underlying conditions. One of these top four conditions was present in nearly all patients (99.2%). The majority of MET calls were made for a relatively small number of underlying conditions and triggers, supporting the concept of 'MET syndromes'. The pattern of interventions is predictable from the triggering condition. This may guide education and training of ward staff to improve detection of deteriorating patients and prevent or pre-emptively manage causes of such deterioration prior to MET criteria being reached. The association between time of day and crisis recognition suggests the hospital system does not reliably detect deteriorating patients. This questions the adequacy of monitoring of deteriorating patients on hospital wards.