UMEM Educational Pearls

Category: Trauma

Title: Lidocaine use for pain management in rib fracture patients.

Keywords: lidocaine, trauma, rib fractures (PubMed Search)

Posted: 6/25/2023 by Robert Flint, MD (Updated: 5/25/2024)
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Use of intravenous lidocaine has been proposed as an adjunct/replacement for opioids in trauma patients with rib fractures. These small studies show a signal that the use of lidocaine decreased the need for opiate pain medication in this cohort of patients. Larger studies are needed, however, trauma surgeons maybe reaching for intravenous lidocaine in patients they are admitting with rib fractures. Also, transdermal lidocaine patches have been shown to have a similar effect in this patient cohort. “In admitted trauma patients with acute rib fractures not requiring continuous intravenous opiates, lidocaine patch use was associated with a significant decrease in opiate utilization during the patients’ hospital course.” 3


1.     Patton, Petrease MD, MSc; Vogt, Kelly MD, MSc; Priestap, Fran MSc; Parry, Neil MD; Ball, Ian M. MD, MSc. Intravenous lidocaine for the management of traumatic rib fractures: A double-blind randomized controlled trial (INITIATE program of research). Journal of Trauma and Acute Care Surgery 93(4):p 496-502, October 2022. | DOI: 10.1097/TA.0000000000003562


2.     Jeff Choi , Kirellos Zamary, Nicolas B. Barreto, Lakshika Tennakoon, Kristen M. Davis, Amber W. Trickey, David A. Spain. Intravenous lidocaine as a non-opioid adjunct analgesic for traumatic rib fractures. Published: September 28, 2020


3.     Johnson M, Strait L, Ata A, et al. Do Lidocaine Patches Reduce Opioid Use in Acute Rib Fractures? The American SurgeonTM. 2020;86(9):1153-1158. doi:10.1177/0003134820945224