Perioperative intravenous lidocaine infusion for postoperative pain control: a meta-analysis of randomized controlled trials

Abstract

Introduction Various strategies have been proposed for postoperative pain control. Among those, intravenous lidocaine infusion (IVLI) has gained in interest. However, its clinical benefit remains unclear. This systematic review is an evaluation of the analgesic efficacy and safety of IVLI during general anesthesia. Methods A systematic search was performed using MED-LINE, EMBASE, Cochrane, and SCOPUS databases, likewise, grey literature. The review included all randomized controlled trials that used a placebo or any comparator and evaluated IVLI during general anesthesia for any type of surgery. Primary outcomes were pain control and opioid requirement. Secondary outcomes were mortality, length of stay, ileus recovery time, nausea/vomiting, and adverse events. Random effects models were used and heterogeneity was assessed using the I 2 index. to -5.56), time to first flatus (WMD -7.62 hr, 95% CI -10.78 to -4.45), time to first feces (WMD -10.71 hr, 95% CI -16.14 to -5.28), nausea/vomiting (risk ratios = 0.71, 95% CI 0.57-0.90), and hospital length of stay (WMD -0.17 days, 95% CI -0.41 to 0.07). Abdominal surgery was strongly associated with benefit. For the 12 studies that systematically screened adverse events, the Results 123Can J Anesth/J Can Anesth (2011) 58:22-37 DOI 10.1007/s12630-010-9407-0 incidence of cardiac and neurologic adverse events was comparable. Eight studies observed toxic plasma levels. Discussion Perioperative IVLI reduced postoperative pain and opioid requirement, as well as ileus recovery time, hospital length of stay, and nausea/vomiting. Intravenous lidocaine infusion was effective mainly in abdominal surgery populations. Considering that toxic levels were detected and that adverse events were not systematically screened for in most studies, dose and safety of IVLI should be established before recommending its use. RésuméIntroduction Plusieurs strate´gies ont e´te´propose´es pour le contrôle de la douleur postope´ratoire. Parmi ces strate´gies, la lidocaı¨ne par voie intraveineuse suscite un inte´reˆt croissant. Toutefois, ses avantages cliniques demeurent peu clairs. Cette revue me´thodique est une e´valuation de l'efficaciteá nalge´sique et de l'innocuite´de la lidocaı¨ne par voie intraveineuse pendant l'anesthe´sie ge´ne´rale. Méthode Une recherche me´thodique a e´te´re´alise´e dans les bases de donne´es MEDLINE, EMBASE, Cochrane et SCOPUS ainsi que dans la litte´rature grise. Cette revue a tenu compte de toutes les e´tudes randomise´es contrôle´es ayant utilise´un placebo ou un traitement de re´fe´rence et e´value´la lidocaı¨ne par voie intraveineuse pendant l'anesthe´sie ge´ne´rale, quel que soit le type de chirurgie. Les principaux crite`res d'e´valuation e´taient le contrôle de la douleur et le besoin en opioı¨des. Les crite`res d'e´valuation secondaires e´taient la mortalite´, la dure´e d'hospitalisation, le temps de re´cupe´ration du transit intestinal, les nause´es et vomissements et les e´ve´nements inde´sirables. Des mode`les a`effets ale´atoires ont e´teú tilise´s e...

Intravenous lidocaine as adjuvant to general anesthesia in renal surgery

“…Although the analgesic effects of systemic lidocaine have been demonstrated for chronic pain especially the neuropathic type, the results for acute pain have been contradictory [19]. Recent meta-analysis [9] has found a significant difference in pain control at rest, during cough, or during movement with the use of intravenous lidocaine infusion in surgical patients under general anesthesia. Perioperative lidocaine infusion was associated with a shorter hospital stay, decreased incidence of nausea or vomiting, and faster return of bowel function, with no impact on in-hospital mortality.…”

“…Perioperative lidocaine infusion was associated with a shorter hospital stay, decreased incidence of nausea or vomiting, and faster return of bowel function, with no impact on in-hospital mortality. These differences were noticeable mainly in abdominal surgery [9,20]. The effect of systemic lidocaine infusion in urological surgery is poorly documented in the literature.…”

“…Lidocaine has also been shown to possess an anti-inflammatory action, and to prevent central hyperalgesia [5]. In humans, the role of intraoperative systemic lidocaine [AQ] infusion was evaluated in pain relief, cytokine response, bowel function recovery, post-operative nausea and vomiting, and length of hospital stay, particularly in abdominal surgery [6–9]. However, the benefit of systemic lidocaine infusion is still controversial when used in others fields such as orthopedic and cardiovascular surgeries reflecting a possible organ dependent effects [10].…”

A comparison between fentanyl plus celecoxib therapy and epidural anesthesia for postoperative pain management following laparoscopic gastrectomy

“…For example, the continuous administration of bupivacaine into the preperitoneal space following LDG has been reported to provide effective pain relief [23]. Intravenous lidocaine and transversus abdominis plane block also may be considered for postoperative analgesia, as previously reported for other abdominal surgeries [24,25]. Further investigation is necessary to determine the ideal postoperative pain management for patients.…”

Lidocaine infusion for continuous interscalene nerve block: Is there evidence for local and systemic benefits?

“…Indeed, an intravenous lidocaine infusion has been used to control chronic pain owing to its local anesthetic and anti-inflammatory properties. 2,3 Future studies will evaluate the use of lidocaine for nerve block infusion and will assess its systemic analgesic effects. …”