Infusion Therapy: For Pain, Headache and Related Conditions

223 Pages·2019·2.768 MB·English

by  Alaa Abd-Elsayed

Infusion
Therapy
For Pain, Headache
and Related Conditions
Alaa Abd-Elsayed
Editor
123
Infusion Therapy
Alaa Abd-Elsayed
Editor
Infusion Therapy
For Pain, Headache and Related
Conditions
Editor
Alaa Abd-Elsayed
Department of Anesthesiology
University of Wisconsin
Madison
WI
USA
ISBN 978-3-030-17477-4 ISBN 978-3-030-17478-1 (eBook)
https://doi.org/10.1007/978-3-030-17478-1
© Springer Nature Switzerland AG 2019
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I would like to dedicate this book to my
parents, my wife and my two beautiful kids
Maro and George
Preface
Dear Reader:
I have found various infusional therapies to be increasingly useful in my pain
management practice, and many patients who had failed other types of treatments
responded to this modality. As my use of infusional treatments for pain has expanded,
so has my awareness of the limitations on guidance for this type of treatment. In
many cases, the use of a specific drug as an intravenous or subcutaneous is not a part
of the FDA-approved labeling of the drug. In other instances, the use of a drug par-
enterally may be accepted and approved, yet the reason for the use of the drug is not
part of the labeling. An example is the increasing use of intravenous lidocaine for
the treatment of pain instead of its formally approved use for cardiac arrhythmias.
Rigorous blinded and controlled studies may not be supported for drugs that are
generic and relatively inexpensive, so in many cases one’s off-label use of an infu-
sional therapy is based upon reported cases or case series. In addition, the novel
application of drugs to diseases outside of our typical practice may provide insight
into how the drugs might have application to our own patient population.
The goal of this book is to provide an overview of various intravenously infused
medications that can serve as a summary of current practice. In many examples in
this book, the applications and use of the drugs are familiar and FDA-approved. In
others, often with the same drugs, the authors seek to provide a summary of less
formalized, yet hopefully useful applications of the medications. A brief overview
of the pharmacology of the drugs is provided, which may provide both useful review
and education on newer mechanistic discoveries that support the use of the medica-
tion. Monitoring guidelines, typical doses and titration processes, and cautions are
included as well, with the intent of providing the practitioner a useful resource for
their practice.
It should be cautioned that the off-label use of infusional therapies may meet
resistance by insurers of health care. While a publication such as this may provide
support for reimbursement for the off-label use of a medication, consideration of the
financial impact of novel infusional treatments may be necessary on an individual
basis.
Finally, like all publications, this is a work that reflects practice at a point in time.
While the authors here present their best interpretation and recommendations for
vii
viii Preface
the use of medications covered in the various chapters, it must be recognized by the
reader that much of this practice will change over time. Professional judgement
must prevail on behalf of the individual patient.
Madison, WI, USA Alaa Abd-Elsayed
Contents
1 Lidocaine Infusion Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Paul R. Hutson and Alaa Abd-Elsayed
2 Ketamine Infusion Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Matt Fischer and Alaa Abd-Elsayed
3 Propofol Infusion Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Ravi K. Grandhi and Alaa Abd-Elsayed
4 Magnesium Infusion Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Andrew J. Wendahl and Adam L. Weinstein
5 Opioid Infusion Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Christi Ann Albert and Cory Sarver
6 Vitamin Infusion Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Peggy Y. Kim and Ann Stumpf
7 Dihydroergotamine Infusion Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Jay Karri and Alaa Abd-Elsayed
8 Bisphosphonate Infusion Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Todd H. Ruth and Veena Graff
9 Phentolamine Infusion Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Michael J. Suer and Alaa Abd-Elsayed
10 Dexmedetomidine Infusion Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Simon Zec, Antony Tharian, Kenneth D. Candido, and
Nebojsa Nick Knezevic
11 Clonidine Infusion Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Nam K. Ly, Jon Livelsberger, and Rany T. Abdallah
12 Benzodiazepine Infusion Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
Thomas Ng, John Akhnoukh, and Neel Mehta
ix
x Contents
13 Immunoglobulin (IVIG) Infusion Therapy . . . . . . . . . . . . . . . . . . . . . . 171
Eileen Bui, Antony Tharian, Kenneth D. Candido, and
Nebojsa Nick Knezevic
14 Ketorolac Infusion Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
Ankur A. Patel, Chandni Patel, Arpit Patel, Navdeep Jassal, and
Ritika Oberoi-Jassal
15 Depacon Infusion Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Greta Nemergut
16 Intravenous Hydration Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
Maxim S. Eckmann and Chad C. Parvus-Teichmann
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
Lidocaine Infusion Therapy 1
Paul R. Hutson and Alaa Abd-Elsayed
Introduction
Lidocaine is an amide local anesthetic that was found in the 1950s to have antiar-
rhythmic effects when infused intravenously. Lidocaine is still used for this purpose
but is usually reserved for patients with ventricular arrhythmias who fail to ade-
quately respond to amiodarone [1]. In current practice, intravenous infusions of
lidocaine are more commonly used for the treatment of neuropathic pain. Local
infiltrations are obviously used for pre-procedural anesthesia and may be used post-
procedure to decrease pain and the need for opioid analgesics. Lidocaine may also
be used topically, such as with cutaneous patches, or as an oral rinse for patients
with pain from mucositis.
Lidocaine is metabolized by CYP1A2 and CYP3A4 in the liver to its active
metabolites MEGX, glycinexylidide (GX), and N-ethylglycine (EG) [2, 3]. MEGX
is considered to have slightly less activity than lidocaine as an inhibitor of the
Na-channel [2]. MEGX and the other metabolites are considered to have greater
analgesic effects on other pathways of neurotransmission such as the glycine recep-
tor than does the parent drug.
Dosing adjustments are not needed in the presence of mild-moderate renal
impairment, and even patients who demonstrate severe impairment of kidney func-
tion may benefit from a single dose of systemic lidocaine for neuropathic pain that
has been reduced by 50% [4, 5].
P. R. Hutson (*)
University of Wisconsin - Madison School of Pharmacy, Madison, WI, USA
e-mail: [email protected]
A. Abd-Elsayed
Department of Anesthesiology, University of Wisconsin School of Medicine and Public
Health, Madison, WI, USA
© Springer Nature Switzerland AG 2019 1
A. Abd-Elsayed (ed.), Infusion Therapy,
https://doi.org/10.1007/978-3-030-17478-1_1