NHS Borders drugs and therapeutics
Lidocaine 5% plasters must not be routinely initiated in hospital.
Initiation is only permitted under clearly defined exception criteria or following completion of a Non‑Formulary Request Form and subsequent approval.
Lidocaine 5% Medicated Plasters - Use in Acute Settings - NHS Borders Procedure
Warning
Objectives
To ensure safe, evidence based and cost-effective prescribing of lidocaine plasters within acute NHS Borders hospital settings in alignment with national Scottish Government guidance on Medicines of Low and Limited Clinical Value (MOLLCV).
This policy restricts their routine initiation and establishes a clear pathway for exceptional prescribing.
Scope
This policy applies to all clinicians (for example medical, pharmacy, nursing independent prescribers) responsible for initiating or reviewing lidocaine plasters within the acute hospital setting.
Audience
All prescribers of Lidocaine Plasters in acute hospital settings
The Scottish Government’s guidance Prescribing – Achieving Value and Sustainability (2024) identifies lidocaine plasters as a medicine of limited clinical value. They should:
- Not be routinely prescribed
- Be used only in recognised exceptional circumstances
Broader national principles recommend that low- or limited‑value medicines should not be initiated unless specific exceptions are met and clinically justified, with deprescribing where safe for existing users
Lidocaine plasters may be considered only for:
Post‑Herpetic Neuralgia (PHN)
A recognised exception under the national “limited clinical value” category.
Use must be justified where alternative therapies are ineffective, contraindicated, or poorly tolerated.
Palliative Care / Complex Pain Managed by Specialist Team
Use when deemed appropriate and in line with the Scottish Palliative Care Guidelines after multidisciplinary specialist pain or palliative care review, in line with principles of person‑centred care.
Lidocaine plasters must not be used for:
- Non neuropathic musculoskeletal pain;
- Non specific chronic back pain;
- Localised pain without neuropathic features;
- Trial use without non formulary request process being followed.
This is consistent with national guidance limiting use to rare exceptions for medicines of limited clinical value.
Before prescribing lidocaine plasters under an approved exception:
Clinical Review
A clinician must document:
- Diagnosis and confirmation that the condition meets exception criteria.
- Previous pain management attempts, including failures/intolerance.
- Expected treatment goal and planned review date.
- Risks/benefits discussed with the patient (Realistic Medicine approach)
Completion of a Non‑Formulary Request Form
All new initiations except for PHN or Palliative Care must be approved through the local Non‑Formulary Request process, including:
- Justification referencing approved exception category.
- Confirmation that alternative therapies have been optimised.
- Approval from a consultant‑level clinician or specialty lead.
- Pharmacy review prior to dispensing
No lidocaine plasters may be supplied until the form is approved.
Initial Trial Period
A maximum 28‑day trial should be used to assess benefit.
Ongoing Review
- Regular reassessment (every 3 months or sooner).
- Attempt deprescribing if insufficient clinical benefit.
Document functional improvement targets where relevant
For patients admitted already using lidocaine plasters:
- Continue temporarily only if clinically appropriate.
- Review by Pain or Palliative Care team.
- Consider deprescribing if no longer meeting exception criteria
- Pharmacy will audit non‑formulary requests quarterly.
- Reports will be reviewed by NHS Borders Area Drugs & Therapeutics Committee (ADTC).
- Outliers and trends will be fed back to clinical teams.
- Policy will be reviewed annually, or earlier if national guidance is updated.