Efficacy and safety of intravenous lidocaine for postoperative analgesia and recovery after surgery: a systematic review with sequential trial analysis. British Journal of Anaesthesia 2016;116(6):770-783 doi:10.1093/bja/aew101

Presented by: Dr H. Pudge

Background

  • Improvement of postoperative pain and other perioperative outcomes remain a significant challenge and a matter of debate among perioperative clinicians.
  • This systematic review aims to evaluate the effects of perioperative i.v. lidocaine infusion on postoperative pain and recovery in patients undergoing various surgical procedures.

Design & Setting

  • Relevant RCTs up until May 2014 searched for in databases.
  • 45 studies and 2 co-publications included in quantitive analysis
  • 42 studies contribute to quantitive analysis

Subjects

  • 45 RCTs published between 1985 & 2014
  • Containing 2802 participants

–1395 received iv lidocaine

–1407 control (saline/no treatment)

  • No overall cohort data

Intervention

  • Meta-analysis including trial sequential analysis

Outcomes

  • Primary Outcomes

–Pain score

–Postoperative ileus

–Functional gastrointestinal recovery

  • Secondary Outcomes

–Length of hospital stay

–Surgical complication

–Adverse events

–Postoperative nausea and vomiting

–Intra- and postoperative opioid requirements

–Functional postoperative neuropsychological scale

–Patient satisfaction

–Cessation of the intervention

Results

  • Iv lidocaine

–Reduced early (md -0.84) and intermediate (-.34) postoperative pain -> laparoscopic/open abdominal surgery.

–Reduced time to first flatus passed (md -5.49 hr), but did not significantly reduce time to first defacaetion

–Reduced hospital stay (md -0.31 days)

–Reduced intraoperative opioid requirements ( md -3.3 meq mg)

Conclusions

  • There is limited evidence suggesting that i.v. lidocaine may be a useful adjuvant during general anaesthesia because of its beneficial impact on several outcomes after surgery

Strengths

  • More trial data for lidocaine v placebo
  • Lots of studies included

Weaknesses

  • Poor evidence strength of iv lidocaine v thoracic epidural anaesthesia
  • No standard lidocaine infusion or bolus– variation across trials included in meta-analysis
  • Small trials included
  • Poor quality evidence for secondary outcomes, not all outcomes analysed

Implications

  • Some evidence that iv lidocaine reduces postoperative pain and early PONV for laparotomy/laparoscopy

Potential for Impact

  • Consider use in abdominal surgery
  • More information/research required on specific types of surgery and in comparison with thoracic epidural anaesthesia