Lidocaine 5% Patch for Treatment of Acute Pain After Robotic Cardiac Surgery and Prevention of Persistent Incisional Pain: A Randomized, Placebo-Controlled, Double-Blind Trial

Vrooman, Bruce; Kapural, Leonardo; Sarwar, Sheryar; Mascha, Edward J.; Mihaljević, Tomislav; Gillinov, A. Marc; Qavi, Shahbaz; Sessler, Daniel I.

doi:10.1111/pme.12721

Cited by 30 publications

(27 citation statements)

References 29 publications

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“…They also used several continuous pain scales (verbal rating scale (VRS), visual analogue scale (VAS), numeric rating scale (NRS), bodily pain sub-component of the Short Form Health Survey (SF-36)). Nine studies did not record pain as a dichotomous outcome but only used continuous pain scales (Blumenthal 2005; Chiu 2008; Gupta 2006; McKeen 2014; O’Neill 2014; Singh 2013; Sprung 2006; Vrooman 2015; Wodlin 2011). One did record pain as a dichotomous out-come but did not report it in the manuscript, and provided the review authors with the data via email (Kurmann 2015).…”

Section: Resultsmentioning

confidence: 99%

“…Null bias might cause studies to underestimate the benefit of regional anaesthesia for the prevention of persistent pain after surgery, if the regional anaesthesia interventions were not effectively delivered (Higgins 2011a; Woods 1995). Indeed, a number of included studies reported no improved pain control in the immediate postoperative period in the experimental (regional anaesthesia) group, as evidenced by inconsequential differences in pain scores between groups perioperatively, or similar requirements of rescue analgesic medications between groups in the immediate postoperative period (Barkhuysen 2010; Baudry 2008; Bollag 2012; Can 2013; Choi 2016; Fassoulaki 2000; Ibarra 2011; Ju 2008; Karmakar 2014; Katz 1996; Lam 2015; Lee 2013; Liu 2015; Loane 2012; McKeen 2014; Micha 2012; Purwar 2015; Singh 2013; Smaldone 2010; Terkawi 2015b; Vrooman 2015; Xu 2017; Zhou 2016). Two review authors therefore extracted information on null bias for each included study and documented their judgement with supporting evidence (see: Characteristics of included studies).…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Local anaesthetics and regional anaesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children

Weinstein

Levene

Cohen

et al. 2018

Cochrane Database of Systematic Reviews

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We conclude that there is moderate-quality evidence that regional anaesthesia may reduce the risk of developing PPP after three to 18 months after thoracotomy and three to 12 months after caesarean section. There is low-quality evidence that regional anaesthesia may reduce the risk of developing PPP three to 12 months after breast cancer surgery. There is moderate evidence that intravenous infusion of local anaesthetics may reduce the risk of developing PPP three to six months after breast cancer surgery.Our conclusions are considerably weakened by the small size and number of studies, by performance bias, null bias, attrition and missing data. Larger, high-quality studies, including children, are needed. We caution that except for breast surgery, our evidence synthesis is based on only a few small studies. On a cautionary note, we cannot extend our conclusions to other surgical interventions or regional anaesthesia techniques, for example we cannot conclude that paravertebral block reduces the risk of PPP after thoracotomy. There are seven ongoing studies and 12 studies awaiting classification that may change the conclusions of the current review once they are published and incorporated.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Local anaesthetics and regional anaesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children

Weinstein

Levene

Cohen

et al. 2018

Cochrane Database of Systematic Reviews

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“…[100][101][102] Thoracic Epidural Anesthesia Thoracic epidural anesthesia is associated with a lower incidence of cardiopulmonary complications and provides excellent postoperative pain control 75,[103][104][105] Despite studies showing decreased pain scores and opioid consumption in the acute postoperative period, no reduction in chronic pain incidence or severity has been shown. 106,107 Intrathecal Opioids Intrathecal opioids are often used in fast-track cardiac anesthesia to improve acute postoperative pain scores.…”

Section: Transdermal Lidocainementioning

confidence: 99%

Chronic Poststernotomy Pain

Kleiman

Sanders

Nemergut

et al. 2017

Regional Anesthesia and Pain Medicine

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Chronic pain following median sternotomy is common after cardiac surgery. If left untreated, chronic sternal pain can reduce quality of life, affecting sleep, mood, activity level, and overall satisfaction. This has a significant societal effect given the large number of cardiac surgeries annually. Although a number of pathophysiologic processes and risk factors are assumed to contribute, the exact cause and major risk factors remain unknown. Moreover, the treatment of chronic poststernotomy pain is often inadequate, relying on opioids and other medications that provide minimal benefit to the patient and have significant adverse effects. Indeed, little is known regarding the prevention of chronic pain development following sternotomy. This review aims to present the current, limited data regarding the incidence, risk factors, treatment, and prevention of chronic poststernotomy pain and to identify areas of future research to improve management of this common complaint following cardiac surgery.

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“…Two weeks after surgery, a difference in mean pain score was still apparent (2.00 vs. 2.93), but was no longer statistically significant ( p = 0.1245) [80]. A randomized, placebo-controlled trial in patients undergoing robotic thoracic surgery concluded that 5% lidocaine plasters did not influence acute or persistent incisional pain, but pain scores in this study were low in both treatment groups [81]. A meta-analysis of efficacy of the plaster in acute pain management reported similar findings, but was limited by the inclusion of only five studies, potential bias from unblinded studies, clinical heterogeneity, and incomplete data regarding adjunct analgesics [82].…”

Section: Supporting Evidence In the Treatment Of Lnpmentioning

confidence: 91%

The 5% Lidocaine-Medicated Plaster: Its Inclusion in International Treatment Guidelines for Treating Localized Neuropathic Pain, and Clinical Evidence Supporting its Use

et al. 2016

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When peripheral neuropathic pain affects a specific, clearly demarcated area of the body, it may be described as localized neuropathic pain (LNP). Examples include postherpetic neuralgia and painful diabetic neuropathy, as well as post-surgical and post-traumatic pain. These conditions may respond to topical treatment, i.e., pharmaceutical agents acting locally on the peripheral nervous system, and the topical route offers advantages over systemic administration. Notably, only a small fraction of the dose reaches the systemic circulation, thereby reducing the risk of systemic adverse effects, drug–drug interactions and overdose. From the patient’s perspective, the analgesic agent is easily applied to the most painful area(s). The 5% lidocaine-medicated plaster has been used for several years to treat LNP and is registered in approximately 50 countries. Many clinical guidelines recommend this treatment modality as a first-line option for treating LNP, particularly in frail and/or elderly patients and those receiving multiple medications, because the benefit-to-risk ratios are far better than those of systemic analgesics. However, some guidelines make only a weak recommendation for its use. This paper considers the positioning of the 5% lidocaine-medicated plaster in international treatment guidelines and how they may be influenced by the specific criteria used in developing them, such as the methodology employed by randomized, placebo-controlled trials. It then examines the body of evidence supporting use of the plaster in some prevalent LNP conditions. Common themes that emerge from clinical studies are: (1) the excellent tolerability and safety of the plaster, which can increase patients’ adherence to treatment, (2) continued efficacy over long-term treatment, and (3) significant reduction in the size of the painful area. On this basis, it is felt that the 5% lidocaine-medicated plaster should be more strongly recommended for treating LNP, either as one component of a multimodal approach or as monotherapy.

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Lidocaine 5% Patch for Treatment of Acute Pain After Robotic Cardiac Surgery and Prevention of Persistent Incisional Pain: A Randomized, Placebo-Controlled, Double-Blind Trial

Abstract: Lidocaine 5% patches did not reduce acute or persistent pain in patients having robotic thoracic surgery, though pain scores were low in both treatment groups. Clinicians should choose alternative analgesic approaches in these patients.

Cited by 30 publications

References 29 publications

Local anaesthetics and regional anaesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children

Local anaesthetics and regional anaesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children

Chronic Poststernotomy Pain

The 5% Lidocaine-Medicated Plaster: Its Inclusion in International Treatment Guidelines for Treating Localized Neuropathic Pain, and Clinical Evidence Supporting its Use

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