As there are now two threads addressing this issue, I will post here, where the original questions were asked, and tag and quote from the other thread as well so that everyone can still easily stay involved.
@zzz so does that mean lidocaine will caused bad effect caused its a sodium channel blocker?
As noted above, lidocaine is a sodium channel blocker. However, it can be used in several ways, and these differ in their risk for people with ME/CFS.
The incidence of side effects of lidocaine with ME/CFS depends on whether it is given locally versus IV, and if given IV, what the rate of administration is. A person's individual situation also factors in here. Lidocaine is a member of the amide family of anesthetics; if people are allergic to any other members of this family, they can be assumed to be allergic to lidocaine as well.
The warning against using sodium channel blockers as general anesthetics in people with ME/CFS definitely applies to lidocaine, as it is a nonspecific sodium channel blocker (meaning that it blocks all subtypes of the sodium channel). However, other uses of lidocaine do not carry this risk for most people, including most people with ME/CFS.
For example, Dr. Goldstein has had great success treating people with ME/CFS and FM for both pain and general symptoms using IV lidocaine. However, whereas IV lidocaine used for general anesthesia is usually given at a dose of about 100 mg over five minutes (the dose varying by the patient's weight), Dr. Goldstein would infuse 200 to 300 mg over a period of two to three hours - an infusion that is slower by a factor of 24. Reducing the infusion rate by 96% like this allowed Dr. Goldstein to treat thousands of ME/CFS and FM patients with virtually no negative reactions. As Dr. Goldstein says on p. 385 of
Tuning the Brain:
Dr.Goldstein said:
I have given IV lidocaine to thousands of patients. The two worst reactions have been urticaria [hives], after which IV lidocaine was no longer effective in the affected individuals. I have seen no seizures, no arrhythmias, and no need for cardiac monitoring...
So it appears that attenuating the infusion rate as Dr. Goldstein did removes all these risks. They may be present, though, in either general anesthesia or local anesthesia, though they do appear to be fairly rare. And as I mentioned above, lidocaine appears to be contraindicated for general anesthesia for people with ME/CFS due to the rapid infusion rate and its effect on blocking sodium channels. Local injection with lidocaine is generally much less risky, as the amount infused is much less.
Based on reading the entire thread, the first example appears to be a very rare reaction. As for the second example, I think that the following quote from that thread sums up the most likely explanation:
After checking multiple references and asking every person in my ER (including the ER doc), we are all in agreement that the lidocaine probably was not the cause of the SVT and it was merely a coincidence.
However, the overriding point here is that since lidocaine is a sodium channel blocker, it has the potential to cause various long-term problems for people with ME/CFS if it is used as a general anesthetic.
Does anyone know if there is a list of the different types of anesthesias and what they channels they block (sodium vs. calcium vs. something else?)
I'm sorry to say that I don't know of any such list.
Since I also have MCAS, this further complicates things in my case b/c I am not supposed to have lidocaine or any of the "caine" meds per the MCAS specialists (although the Masto Society says that some "caine" meds are tolerated better than others per their list of ER Room Protocols.)
As for lidocaine and mast cell degranulation:
The mastocytosis society (TMS) puts out a list of meds to avoid and those that a generally considered safe and Lidocaine has always been on the list to avoid. I assume it degranulates mast cells and can cause anaphylaxis but I do not know the mechanism or anything beyond that.
@Gingergrrl : I am seeing the opposite of this. Here is the
Mastocytosis Society's "Emergency Room Protocols," and they list lidocaine as "typically tollerated" on page 11. It seems it
might actually decrease histamine release (the study was on mice and in vitro human basophils).
I encountered
@aaron_c's reference a year ago, and it seemed to fit in well with Dr. Goldstein's description of how lidocaine decreases glutamate production, which can have a downstream effect of reducing mast cell degranulation. This would be particularly true in Dr. Goldstein's slow infusion lidocaine treatment.
On the other hand, I have seen references to events where lidocaine used for local anesthesia triggered mast cell reactions. Once again, the speed of infusion seems to be critical here, as lidocaine used for local anesthesia is infused much faster than Dr. Goldstein's method, even though the area of application is much smaller.
@Gingergrrl mcas, is it histamine issue with lidocaine?
I do read about histamine and lidocaine connection. Theres also a thread here while ago.
Once again, this comes down to how the lidocaine is administrated. All the histamine reactions I have read about have been in connection with local anesthesia. The sources that
@aaron_c quote implies that this is not an issue for general anesthesia, and Dr. Goldstein definitely did not find it to be an issue using his protocol.
@kisekishiawase Your links are to IV lidocaine. I'd guess that local injections might have a different effect because of the amount of lidocaine administered. I have had heart rhythm problems but have never had them after a lidocaine injection.
I would agree with
@Sushi that the amount of the dose plays a crucial role here.
I had Lidocaine infused into my blood stream back in 2009. My pain was off the charts, helped me get back to "normal". LOL I believe they mentioned I could have a heart attack from the procedure, but I did not care! I needed relief, if it was going to be long -term, so be it!
This is an excellent example of how Dr. Goldstein used lidocaine, though the mention of a possible heart attack implies that you may have been infused at a faster rate than Dr. Goldstein used.
