The use of 5% lidocaine medicated plaster for acute postoperative pain after gynecological surgery

Abstract

Objectives:To examine the feasibility and potential efficacy of 5% lidocaine medicated plaster for acute postoperative pain in a parallel, blinded, randomized controlled pilot trial.Methods:Twenty-eight women undergoing elective gynecological surgery with midline incisions were randomly allocated 5% lidocaine medicated patch (Lignopad) or placebo plasters. Postoperative pain at rest and on movement at 24 hours were the primary study endpoints, with secondary endpoints of postoperative pain within the first 48 hours, cumulative morphine consumption (mg), predicted peak flow rate (PFR) (%) and adverse effects. We assessed pain scores at rest and on movement using the visual analogue scale (0–100).Results:The lidocaine patch group had lower postoperative pain scores at rest at 24 hours (mean difference [MD] −15.1, 95% confidence interval [95% CI] −28.3 to −2.0; P = .024) but not on movement at 24 hours (MD −6.4, 95% CI −22.7 to 9.9; P = .445). Compared to placebo, lidocaine may slightly lower cumulative morphine consumption (mg) over time (MD −3.4, 95% CI −6.9 to 0.2; group∗time interaction P = .065). The difference in improvement in the PFR over time after surgery between groups appeared small (group∗time P = .0980). No adverse effects occurred.Conclusions:Lidocaine patch may provide a clinically important reduction in postoperative pain intensity. A larger trial to confirm the efficacy and safety of lidocaine patch is feasible after modifying the inclusion criteria and collecting patient-centered outcomes, such as quality of recovery and patient satisfaction.

Lidocaine patches for postcesarean pain control in obese women: a pilot randomized controlled trial

“…41 However, since that time, a small RCT was performed with 28 participants undergoing hysterectomy via planned vertical midline laparotomy incision, and this trial showed a nonstatistically significant trend in decreased cumulative MME usage; this group is planning a larger trial. 62 We did not find such a trend, but our population used a Pfannenstiel incision rather than a vertical midline incision, and in addition, the RCT on hysterectomy placed the patches directly adjacent to the incision. 62 At the start of our trial, there was 1 other trial investigating the use of lidocaine patches on postcesarean pain listed on Median pain scores overall and by prepregnancy and delivery BMI…”

“…62 We did not find such a trend, but our population used a Pfannenstiel incision rather than a vertical midline incision, and in addition, the RCT on hysterectomy placed the patches directly adjacent to the incision. 62 At the start of our trial, there was 1 other trial investigating the use of lidocaine patches on postcesarean pain listed on Median pain scores overall and by prepregnancy and delivery BMI…”

“…Based on the existing literature on the use of lidocaine patches after noncesarean surgeries, some studies applied the patches directly to the incisions, 38 but other studies demonstrated efficacy when patches were applied around the incision. 36,39,61,62 Thus, the application site may not have been the reason for the lack of efficacy. Second, lidocaine patches may be less effective for laparotomy incisions.…”

Efficacy And Safety Of 5% Lidocaine Patches For Postoperative Pain Management In Patients Undergoing Unilateral Inguinal Hernia Repair: Study Protocol For A Prospective, Double-Blind, Randomized, Controlled Clinical Trial

“…In a randomized controlled trial of 70 patients who underwent radical retropubic prostatectomy with a lower midline incision, a lidocaine patch was applied for 24 hours after the surgery, resulting in reduced pain scores and opioid consumption (13). A similar trial conducted on 28 patients who underwent open gynecological surgery with a midline incision found that postoperative pain reduced with lidocaine patch use (14).…”

Topical agents: a thoughtful choice for multimodal analgesia

“…Moreover, it has been increasingly used in other neuropathic conditions [ 30 , 31 ] and many pain-related conditions due to its ease of use and low systemic adverse effects [ 32 , 33 ]. Several studies have supported that LP provide adequate postoperative pain relief after various surgeries, including laparoscopic appendectomy [ 34 ], gynecological surgery with midline incision [ 35 ], radical prostatectomy [ 36 ], and endoscopic discectomy [ 37 ]. LP are 10 ⅹ 14 cm sized hydrogel adhesive patches containing 700 mg of lidocaine at a 5% concentration.…”