Wednesday, September 28, 2005

IV lidocaine for cholestatic pruritis

October's American J of Medicine has a brief report of a small blinded trial comparing IV lidocaine to placebo for cholestatic pruritis. 12 patients received 100mg IV lidocaine over 5 minutes (6 received placebo) & visual analogue scale recordings of pruritis were recorded for 7 days afterwards. Basically, there was a significant difference in itching on the 100mm scale (70mm before to 40mm afterwards on average) on days 2 and 3. There was essentially zero change in the placebo patients. Clearly the IV lidocaine had a salutary affect on itching--whether it is feasible (are people going to get q4day dosing of iv lido?), whether the magnitude of the effect is worth the cost/risk, & whether alternative agents (mexilitine) are worthwhile remain to be seen.

Also--I wanted to highlight a wonderful comment on my last post by Lyle Fettig which addressed, among other things, some of my frustration with the Lancet end of life perspectives series this way:
"Perhaps by reading these articles, one develops a broader "differential" regarding the meaning of death in individuals, regardless of their religion or lack thereof."
Click on the comment link below the post to read it in full. Thanks Lyle.

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