Lidocaine swallow analgesia for severe painful prolonged esophageal disorders.

Dear Editor,

Esophageal pain is a distressing symptom in patients with esophageal tumor, inflammation, lesions, and foreign body.[12] Lidocaine swallow provides reliable topical analgesia for the esophagogastric tract in emergency situations.[2] However, there is no publication regarding the use of lidocaine swallow analgesia for nonemergent esophageal pain. This is a case series of lidocaine swallow analgesia for severe prolonged esophageal pain in three continents.

Ten elderly patients at a Nigerian hospital, with painful esophageal tumor, were scheduled for esophagectomy. During presurgical optimisation, their esophageal pain worsened. Oral tramadol, acetaminophen, and antacid were inadequate. Subsequent lidocaine-laced drinks provided 50% pain reduction. Lidocaine dose was 1 mg/kg/h or 24 mg/kg/day, but maximum of 2000 mg/day. Lidocaine drink concentration was 0.5–0.8 mg/mL. Patients drank 2500–3300 mL of fluid per day.

Seven adult patients presented to a British hospital with chronic esophagitis. Oral pantoprazole, codeine, acetaminophen, and antacid were ineffective. Subsequent lidocaine-laced drinks were commenced; with 70% pain reduction. Lidocaine dose was 1.3 mg/kg/h or 31 mg/kg/day, but maximum of 2400 mg/day. Lidocaine drink concentration was 0.7–0.9 mg/mL. Patients drank 2500–3500 mL of fluid daily. Five adult patients presented to a Canadian pain clinic with chronic drug-induced esophagitis. Oral metoclopramide, pantoprazole, acetaminophen, and antacid were inefficacious. Lidocaine-laced drinks produced 70% pain reduction; at dose of 1.3 mg/kg/h or 31 mg/kg/day, and maximum of 2400 mg/day. Lidocaine drink concentration was 0.7–0.9 mg/mL. Patients drank 2500–3000 mL of fluid per day.

Prolonged severe esophageal pain is problematic.[1] Lidocaine-laced drink is more effective at relieving severe esophageal pain; compared to pantoprazole, analgesics, and antacids.[2] Topical lidocaine provides effective analgesia for esophageal and oral procedures.[23] Therefore, lidocaine swallow analgesia should be employed regularly for the management of chronic or prolonged severe esophageal pain. This is the first publication to highlight the use of lidocaine swallow analgesia for prolonged severe esophageal pain management.

This report shows that lidocaine analgesia of the gastrointestinal tract is simple and safe; and is corroborated by published clinical data.[23] Risk of lidocaine systemic toxicity is very low at the standard doses used in our study: at 1.3 mg/kg/h or 31 mg/kg/day, up to maximum of 2400 mg/day. Published data showed that nonfatal lidocaine toxicity occurred after extremely high dose of 4800 mg/day.[4] This excessive dose is twice the dose that was used in our case report, and such high dose is not recommended.

This case series of clinical experience, from three continents, shows that lidocaine swallow analgesia is effective and safe for the management of prolonged severe esophageal pain in nonemergent settings. This simple and reliable analgesia should be employed regularly in suitable patients with prolonged esophageal pain; including patients undergoing cancer or palliative care.

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Conflicts of interest

There are no conflicts of interest.