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Parenteral lignocaine in cancer neuropathic pain: A series of case reports

Abstract Neuropathic cancer pain is a clinical challenge and significantly more difficult to treat. The treatment approach differs from nociceptive pain. Use of parenteral lignocaine has been studied extensively in postoperative and neuropathic chronic pain syndromes, and its use in cancer pain is extrapolated from this research. We report on our experience in using parenteral lignocaine in four patients admitted to an inpatient hospice unit. All four patients suffered neuropathic pain from tumour involvement. Delirium with confusion and drowsiness was present in all four patients, precluding the use of adjuvants such as ketamine which could potentially aggravate confusion. In all four patients, there was a positive response to a parenteral lignocaine bolus of 50 mg. With an objective reduction in pain after the bolus, a continuous lignocaine infusion was initiated. The duration of infusions ranged from 2 to 13 days, and the infusion dosages were between 800 and 1500 mg per day. There were no documented adverse effects at these doses. The mean equivalent daily dose of morphine remained stable during the duration of treatment with lignocaine. In our experience, parenteral lignocaine can be used safely in an inpatient hospice care setting and should be considered as part of the analgesic armamentarium to manage cancer neuropathic pain, even at the terminal phase.