What question did this study set out to answer?

To evaluate the efficacy and adverse effects of continuous perioperative intravenous lidocaine infusion compared with placebo, no treatment, or thoracic epidural analgesia for postoperative pain relief and surgical recovery in adults.

June 4, 2018Cochrane library

Continuous intravenous perioperative lidocaine infusion for postoperative pain and recovery in adults

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To evaluate the efficacy and adverse effects of continuous perioperative intravenous lidocaine infusion compared with placebo, no treatment, or thoracic epidural analgesia for postoperative pain relief and surgical recovery in adults.
Systematic search across CENTRAL, MEDLINE, Embase, and CINAHL up to January 2017.
Inclusion of 68 randomized controlled trials comprising 4,525 adults undergoing elective or urgent surgery under general anesthesia, receiving IV lidocaine (1 to 5 mg/kg/h) started pre-incision versus placebo, no treatment, or epidural analgesia.
Evaluation of primary endpoints (rest pain, gastrointestinal recovery, adverse events) and secondary outcomes using Cochrane methods and GRADE certainty assessments.
Compared with placebo/no treatment, IV lidocaine had uncertain effects on pain at 1–4 hours (SMD -0.50, 95% CI -0.72 to -0.28; 29 studies, N=1656; very low-quality) and ruled out clinically meaningful pain reductions at 24 hours (SMD -0.14, 95% CI -0.25 to -0.04; 33 studies, N=1847) and 48 hours (SMD -0.11, 95% CI -0.25 to 0.04; 24 studies, N=1404; moderate-quality).
Compared with placebo/no treatment, reductions in ileus (RR 0.37, 95% CI 0.15 to 0.87; 4 studies, N=273), time to first bowel movement (MD -7.92 hours, 95% CI -12.71 to -3.13; 12 studies, N=684), postoperative nausea (RR 0.78, 95% CI 0.67 to 0.91; 35 studies, N=1903), and opioid use (MD -4.52 mg morphine equivalents, 95% CI -6.25 to -2.79; 40 studies, N=2201) remained uncertain due to very low-quality evidence.
Comparisons with thoracic epidural analgesia (2 trials, N=102) showed inconclusive differences for pain at 24 hours (MD 1.51, 95% CI -0.29 to 3.32) and 48 hours (MD 0.98, 95% CI -1.19 to 3.16), with very low-quality evidence across all outcomes.

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Implication

Systematic review reveals uncertain pain and recovery benefits of perioperative intravenous lidocaine in surgical patients, highlighting low-quality evidence.

Cite This Study

Weibel et al. (2018) studied this question.

synapsesocial.com/papers/6a76a956e29fd788c9f6bb78 https://doi.org/10.1002/14651858.cd009642.pub3

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Implication

Systematic review reveals uncertain pain and recovery benefits of perioperative intravenous lidocaine in surgical patients, highlighting low-quality evidence.

Continuous intravenous perioperative lidocaine infusion for postoperative pain and recovery in adults

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Discussion

Implication

Cite This Study

Continuous intravenous perioperative lidocaine infusion for postoperative pain and recovery in adults

Key Points

Discussion

Implication

Cite This Study

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