What are Lidocaine and Ketamine Infusions?
Ketamine has been used in surgical anesthesia for many years. It has unique properties which improve anesthesia safety, reduce pain, and improve mood.
Lidocaine and ketamine infusions are advanced treatment modalities used in pain management to alleviate chronic and neurologic pain conditions. Lidocaine, a local anesthetic, is administered intravenously to help reduce pain signals in the body with minimal side effects. Ketamine, traditionally used as an anesthetic, is also delivered intravenously and has been found to be effective in treating various types of neuropathic pain. These infusions are gaining popularity in pain medicine due to their ability to provide significant relief for patients who have not responded to other treatment options.
How do you prepare for Lidocaine and Ketamine Infusions?
Preparing for lidocaine and ketamine infusions typically involves a consultation with your healthcare provider to discuss your medical history, current medications, and any concerns or questions you may have about the procedure. Depending on your individual needs, your healthcare provider may recommend certain pre-infusion protocols, such as fasting for a specified period before the infusion or temporarily discontinuing certain medications that could interact with lidocaine or ketamine. It’s essential to follow any instructions provided by your healthcare provider to ensure the safety and effectiveness of the infusion treatment.
Why are Lidocaine and Ketamine Infusions performed?
Lidocaine is an intravenous infusion used for chronic pain, with minimal side effects. Ketamine infusion is also used intravenously to treat neurologic pain. Both are becoming increasingly more common in Pain medicine.
What can you expect during Lidocaine and Ketamine Infusions?
Ketamine gained notoriety in the 90’s as a recreational drug, referred to as “special K” and associated with veterinary anesthesia. In the past decade, though, it has emerged as a powerful analgesic and antidepressant in the right setting.
Used in very low doses – doses lower than those used for anesthesia – ketamine reduces pain and resets the pain centers of the brain. It allows for neuroplasticity, reorganization of pain programming in the nervous system.
For depression and post-traumatic stress disorder (PTSD), ketamine is also helpful when traditional medication options have failed.
As depression and PTSD frequently accompany chronic pain, low-dose ketamine becomes a powerful tool for patients.
For the first ketamine visit, we want to determine:
- How does the patient tolerate the medication? Ketamine may cause an out-of-body experience. Some patients describe kaleidoscope vision, or an Alice in Wonderland type of experience.
- Are there side effects (eg. elevated blood pressure)
- Is it helpful for pain and/or mood? If so, how helpful, and how long does it last?
To do this, we start an IV in a monitored setting and administer 10mg of ketamine. We see how the patient responds and measure vital signs. Possible responses:
- Anxiety – patient is uncomfortable with the experience. We then give midazolam IV to sedate the patient and end the experience.
- Analgesia without dissociation – we have found the ideal therapeutic dose to reduce pain and not cause an out-of-body experience.
- Dissociation – this is the out-of-body experience which most patients find quite pleasant.
- Nothing. Some patients require a higher dose, so an additional 5-10mg is given.
For 2 and 3 above, based on the dose required, we start an infusion which is run over 45 minutes. Many patients work with a mental health specialist who prepares an audio track for use during the infusion and follows up with them after. Based on the response to the initial infusion, we may set up a series of infusions (usually weekly x8 weeks) or prescribe for home use (strictly controlled).
At the initial visit, after arriving at an anatomic understanding of the patient’s pain process, we will discuss all treatment options.
We consider ketamine when there is:
- Hypersensitivity of the nervous system
- Severe pain that has not responded to other medications
- Opioid dependence with a desire to taper off
- Coexisting depressed mood
More information is available in our informed consent.
What is the followup and recovery like for Lidocaine and Ketamine Infusions?
The follow-up and recovery process for lidocaine and ketamine infusions may vary depending on the individual and the specific pain condition being treated. After the infusion, you may experience some mild drowsiness, dizziness, or nausea, which should resolve on its own shortly after the treatment. It’s essential to arrange for someone to drive you home after the infusion, as you may not be in a suitable condition to operate a vehicle immediately afterward. Your healthcare provider will provide personalized post-infusion instructions and schedule any necessary follow-up appointments to monitor your progress and adjust your treatment plan as needed.
What are the potential risks for Lidocaine and Ketamine Infusions?
While lidocaine and ketamine infusions are generally safe when administered by trained healthcare professionals, there are potential risks and side effects to be aware of. Common side effects may include drowsiness, dizziness, nausea, or changes in blood pressure or heart rate during the infusion. In rare cases, more serious complications such as allergic reactions, hallucinations, or cardiovascular issues may occur, but these instances are exceedingly rare when proper protocols are followed. It’s essential to discuss any concerns or pre-existing medical conditions with your healthcare provider before undergoing infusion therapy to minimize the risk of adverse effects.
Are there related procedures to Lidocaine and Ketamine Infusions?
Nerve blocks or epidural injections may be used in conjunction with infusion therapy to provide targeted pain relief for specific regions of the body. Additionally, other advanced pain management modalities such as spinal cord stimulation or intrathecal drug delivery systems may be considered for patients who do not respond adequately to infusion therapy alone. Your healthcare provider can discuss all available treatment options with you and develop a comprehensive plan tailored to your individual needs and goals.
