4CPS-165\u2005Lidocaine 5% plaster: is it worth the pain?

Abstract

Background Lidocaine 5% plaster is licensed for the symptomatic relief of pain associated with post-herpetic neuralgia. Over the past 4 years, an increase of more than 50% of its consumption has been observed within our hospital. Purpose The objective of this work was to evaluate the use of this drug in our institution as well as the impact of hospital practices on primary care. Material and methods A retrospective study of 5% lidocaine plaster prescriptions was conducted from 1 January 2017 to 1 May 2018. Using computerised and physical patient records, the following data were collected: age, service, indication, dosage, duration of prescription and mention on the discharge prescription. In parallel, the evolution of hospital spending on this drug was compared to the evolution of the expenses generated by hospital outpatients’ prescriptions. Results In this evaluation, 111 prescriptions of lidocaine 5% plaster were analysed for the period studied. The average age of patients was 72 years (18–99 years). Less than half of the prescriptions mentioned the therapeutic window (53/111). The largest prescribing services were the palliative care unit (36/111) and the geriatric long-term care unit (28/111). Regarding the indications, only 3% (3/111) of the prescriptions matched the official labelling, 79% (88/111) were off-label and 18% (20/111) did not specify an indication. The lidocaine 5% plaster was mentioned on approximately 50% of the discharge prescriptions. Conclusion Most of the prescriptions analysed concern off-label indications initiated by doctors specialised in pain management. The bibliographic review shows efficacy results that vary from one publication to another. In consequence it is necessary to set up a multidisciplinary working group to supervise the prescription procedures in our hospital (characterisation and evaluation of neuropathic pain, validation of the main indications). This initiation of this work already shows an impact on primary care: since the introduction of a systematic pharmaceutical control on the dispensing of this drug within the hospital, expenses in community pharmacies were reduced by 16% (€2\u200932\u2009000 in 2016 versus €1\u200995\u2009000 in 2017). This first evaluation allows us to assess the use in real life of an increasingly prescribed anaesthetic medication. References and/or acknowledgements https://www.has-sante.fr/portail/upload/docs/application/pdf/2012–06/versatis_ct_8107.pdf No conflict of interest.