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Intravenous (IV) infusion of anesthetic agents, generally lidocaine or ketamine, has been proposed for treatment of chronic neuropathic pain (e.g., phantom limb pain, post-herpetic neuralgia, complex regional pain syndromes, diabetic neuropathy, and pain related to stroke or spinal cord injuries), other forms of chronic pain (e.g., chronic daily headache and fibromyalgia), and psychiatric disorders (e.g., depression, treatment-resistant depression, bipolar disorder, and PTSD).
Lidocaine prevents neural depolarization through effects on voltage-dependent sodium channels and is FDA approved as an anesthetic. IV lidocaine for the treatment of chronic pain is an off-label use. Mild adverse effects include general fatigue, somnolence, dizziness, headache, periorbital and extremity numbness and tingling, nausea, vomiting, and tremors. Severe adverse effects include arrhythmias, seizures, loss of consciousness, confusion, and even death.
Ketamine, a schedule III controlled substance, is an antagonist of the NMDA receptor and a dissociative anesthetic and is FDA approved as an anesthetic. IV ketamine for the treatment of chronic pain and psychiatric disorders are off-label uses. Respiratory depression may occur, and emergence reactions vary in severity from pleasant dream-like states to hallucinations, delirium, and dysphoria, and can be accompanied by confusion, excitement, aggression, or irrational behavior.
I. Intravenous Anesthetics for Chronic Pain
Intravenous infusion of anesthetics (e.g., ketamine or lidocaine) is considered EXPERIMENTAL/INVESTIGATIVE for the management of chronic pain indications (e.g., chronic neuropathic pain, chronic daily headache, and fibromyalgia) due to a lack of evidence demonstrating its safety and effectiveness.
II. Intravenous Anesthetics for Psychiatric Disorders
Intravenous infusion of anesthetics (e.g., ketamine) is considered EXPERIMENTAL/INVESTIGATIVE for the treatment of psychiatric disorders (e.g., depression, bipolar disorder, and post-traumatic stress disorder [PTSD]) due to a lack of clinical evidence demonstrating its safety and effectiveness.
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Note that services with specific coverage criteria may be reviewed retrospectively to determine if criteria are being met. Retrospective denial of claims may result if criteria are not met.
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Acknowledgements:
CPT® codes copyright American Medical Association® 2023. All rights reserved.
CDT codes copyright American Dental Association® 2023. All rights reserved.
