Efficacy of transdermal 4% lidocaine patches for postoperative pain management after arthroscopic rotator cuff repair: a prospective trial

Lee, Donghoon; Campbell, Richard E.; Leider, Morgan; Pepe, Matthew D.; Tucker, Bradford S.; Tjoumakaris, Fotios P.

doi:10.1016/j.jseint.2021.09.006

Cited by 5 publications

(14 citation statements)

References 15 publications

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“…Therefore, we extracted and analyzed the pain scores at 12, 24, and 48 hours after the operation. Five trials recorded postoperative pain scores at 12 hours, 12,14,23,25,26 10 trials recorded postoperative pain scores at 24 hours, 12–14,17,21–26 and 5 trials recorded postoperative pain scores at 48 hours 13,16,22,23,25 . The analysis indicated that pain scores in the lidocaine patch groups were significantly lower (MD=−1.32 [95% CI, −1.96 to −0.68], P <0.0001; I 2 =92%) at 12 hours after the operation (Fig.…”

Section: Resultsmentioning

confidence: 94%

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Is Lidocaine Patch Beneficial for Postoperative Pain?

Wu¹,

Wei

et al. 2023

The Clinical Journal of Pain

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Objectives: The aim of this meta-analysis was to evaluate whether a lidocaine patch is beneficial for postoperative pain as an option for multimodal analgesia. Methods: Information was obtained from PubMed, Embase, and the Cochrane Central Register of Controlled Trials for clinical randomized controlled trials of lidocaine patches for postoperative pain (as of March 2022). Two researchers independently completed study screening, risk bias assessment, and data extraction. Review Manager (version 5.4, Cochrane Collaboration) was used to conduct the meta-analysis. The evaluation metrics were postoperative pain scores, opioid consumption, and patient satisfaction. Results: Sixteen randomized controlled trials were included, and data from 918 patients were available. Pain scores differed between the 2 groups at 12, 24, and 48 hours postoperatively, and the pain scores of the lidocaine patch group were significantly lower (mean difference [MD]=−1.32 [95% CI, −1.96 to −0.68], P<0.0001; I 2=92%) at 12 hours after the operation; (MD=−1.23 [95% CI, −1.72 to −0.75], P<0.00001; I 2=92%) at 24 hours after the operation; and (MD=−0.25 [95% CI,−0.29 to −0.21], P<0.00001; I 2=98%) at 48 hours after the operation. In addition, the lidocaine patch group had decreased opioid requirements (MD=−3.57 [95% CI, −5.06 to −2.09], P<0.00001; I 2=96%). The lidocaine patch group seemed to be more satisfied, but there was no statistically significant difference (risk ratio, 1.50 [95% CI, 0.74 to 3.05], P=0.26) between the groups. Discussion: Lidocaine patches are beneficial for postoperative pain and can be used in multimodal analgesia to reduce opioid use, but there is no significant increase in patient satisfaction with pain control. More data are needed to support this conclusion due to the large heterogeneity in the present study.

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Section: Resultsmentioning

confidence: 94%

“…A total of 140 studies (PubMed 43, Cochran 71, and Embase 26) were retrieved. After screening, 16 randomized controlled trials (RCTs) were included 12–14,16–28 . The data from 918 patients were obtained, of which 462 patients used lidocaine patches, and 456 patients did not use patches or used blank patches.…”

Section: Resultsmentioning

confidence: 99%

Is Lidocaine Patch Beneficial for Postoperative Pain?

Wu¹,

Wei

et al. 2023

The Clinical Journal of Pain

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“…This study found no signifi-cant difference in pain scores or opioid consumption between the lidocaine group and the control group. Furthermore, patients in the lidocaine group were less satisfied with their pain control between postoperative days 2 and 8 23 .…”

Section: Other Interventionsmentioning

confidence: 92%

“…Four studies (19.0%) assessed local pain management modalities, such as transcutaneous electrical nerve stimulation (TENS), cryotherapy, or bandaging 18,22,25,34 . One study each (4.8%) evaluated topical treatment (lidocaine gel patch) 23 and relaxation therapy 27 .…”

Section: Study Characteristicsmentioning

confidence: 99%

“…After removal of duplicates, 1,785 unique studies underwent title/ abstract screening, with 63 undergoing full-text screening. Ultimately, 21 studies were included in final data extraction and analysis [10][11][12][13][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] . Figure 1 shows the number of studies at each step of the screening process.…”

Section: Study Selectionmentioning

confidence: 99%

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Opioid-Sparing Strategies in Arthroscopic Surgery

et al. 2023

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Background: Opioid overprescription is a problem in orthopaedic surgery. Arthroscopic surgery, given its minimally invasive nature, represents an opportunity to minimize opioid prescription and consumption by using effective pain management adjuncts. Thus, the primary question posed in this study was which noninvasive pain management modalities can effectively manage pain and reduce opioid intake after arthroscopic surgery. Methods: The databases PubMed, MEDLINE, EMBASE, Scopus, and Web of Science were searched on August 10, 2022. Randomized controlled trials (RCTs) evaluating noninvasive pain management strategies in arthroscopy patients were evaluated. Eligible studies were selected through a systematic screening process. Meta-analysis was performed for pain scores and opioid consumption at time points which had sufficient data available. Results: Twenty-one RCTs were included, with a total of 2,148 patients undergoing shoulder, knee, and hip arthroscopy. Meta-analysis comparing nonopioid, oral analgesic regimens, with or without patient education components, with the standard of care or placebo demonstrated no difference in pain scores at 24 hours, 4 to 7 days, or 14 days postoperatively. Nonopioid regimens also resulted in significantly lower opioid consumption in the first 24 hours postoperatively (mean difference, −37.02 mg oral morphine equivalents, 95% confidence interval, −74.01 to −0.03). Transcutaneous electrical nerve stimulation (TENS), cryotherapy, and zolpidem were also found to effectively manage pain and reduce opioid use in a limited number of studies. Conclusions: A range of noninvasive pain management strategies exist to manage pain and reduce opioid use after arthroscopic procedures. The strongest evidence base supports the use of multimodal nonopioid oral analgesics, with some studies incorporating patient education components. Some evidence supports the efficacy of TENS, cryotherapy, and nonbenzodiazepine sleeping aids. Direction from governing bodies is an important next step to incorporate these adjuncts into routine clinical practice to manage pain and reduce the amount of opioids prescribed and consumed after arthroscopic surgery. Level of Evidence: Level II, systematic review and meta-analysis of RCTs. See Instructions for Authors for a complete description of the levels of evidence.

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Arthroscopy Association of Canada Position Statement on Opioid Prescription After Arthroscopic Surgery

Nucci,

Degen,

Ekhtiari

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background: Despite the ongoing opioid epidemic, most patients are still prescribed a significant number of opioid medications for pain management after arthroscopic surgery. There is a need for consensus among orthopaedic surgeons and solutions to aid providers in analgesic strategies that reduce the use of opioid pain medications. Purpose: This position statement was developed with a comprehensive systematic review and meta-analysis of exclusively randomized controlled trials (RCTs) to synthesize the best available evidence for managing acute postoperative pain after arthroscopic surgery. Study Design: Position statement. Methods: The Embase, MEDLINE, PubMed, Scopus, and Web of Science databases were searched from inception until August 10, 2022. Keywords included arthroscopy, opioids, analgesia, and pain, and associated variations. We included exclusively RCTs on adult patients to gather the best available evidence for managing acute postoperative pain after arthroscopic surgery. Patient characteristics, pain, and opioid data were extracted, data were analyzed, and trial bias was evaluated. Results: A total of 21 RCTs were identified related to the prescription of opioid-sparing pain medication after arthroscopic surgery. The following recommendations regarding noninvasive, postoperative pain management strategies were made: (1) multimodal oral nonopioid analgesic regimens—including at least 1 of acetaminophen—a nonsteroidal anti-inflammatory drug—can significantly reduce opioid consumption with no change in pain scores; (2) cryotherapy is likely to help with pain management, although the evidence on the optimal method of application (continuous-flow vs ice pack application) is unclear; (3) and (4) limited RCT evidence supports the efficacy of transcutaneous electrical nerve stimulation and relaxation exercises in reducing opioid consumption after arthroscopy; and (5) limited RCT evidence exists against the efficacy of transdermal lidocaine patches in reducing opioid consumption. Conclusion: A range of nonopioid strategies exist that can reduce postarthroscopic procedural opioid consumption with equivalent vocal pain outcomes. Optimal strategies include multimodal analgesia with education and restricted/reduced opioid prescription.

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Efficacy of transdermal 4% lidocaine patches for postoperative pain management after arthroscopic rotator cuff repair: a prospective trial

Cited by 5 publications

References 15 publications

Is Lidocaine Patch Beneficial for Postoperative Pain?

Is Lidocaine Patch Beneficial for Postoperative Pain?

Opioid-Sparing Strategies in Arthroscopic Surgery

Arthroscopy Association of Canada Position Statement on Opioid Prescription After Arthroscopic Surgery

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