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
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