May I know the lidocaine dose to manage infusion pain?

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Rose B., Doctor/MD from Philippines asked
May I know the lidocaine dose to manage infusion pain?

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Nurse Canada with members of the ISPD Nursing Committee March 8, 2024

We thank you for your question. Pain on infusion of the PD fluid can be multifactorial. We have listed information here taken from the “UHN (University Health Network, Toronto, Canada) Division of Nephrology House Staff/NP Guidebook” for a local practice. The authors recommend that lidocaine (Xylocaine®), without Epinephrine, should be used only if, after investigations, the pain is related to the dialysis solution to avoid the risk of masking pain related to other causes (e.g. appendicitis, cholecystitis, pancreatitis, peritonitis). If the source of abdominal cramps or pain is not known, then lidocaine should not be used. The suggested dose is: 1% lidocaine – 2.5 mL/L IP. (1, page 99)
 
Slowing the rate of PD solution inflow with CAPD by lowering the height of the PD solution bag may help with infusion pain. If your PD center has access to the new low GDP, neutral pH PD solutions, use of these may decrease inflow pain because they are less acidic than the standard PD solutions. (2)
 
1.Gozdzik A, editor. UHN Division of Nephrology House Staff/NP Guidebook. January 2024. https://ukidney.com/nephrology-publications/nephrology-manuals/university-health-network-nephrology-manual.
 
2.Ambarsari CG, Cho Y and Johnson DW. Peritoneal Dialysis Solutions. In: Nissenson AR, Fine RN, Mehrotra R, et al. (eds) Handbook of Dialysis Therapy. 6th ed.: Elsevier, 2023, pp.222-229.

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