Effects of perioperative intravenous lidocaine infusion for postoperative pain and recovery in elderly patients undergoing surgery: a systematic review and meta-analysis of randomized controlled trials

Background Improving postoperative pain and other potential benefits of IV lidocaine remains a significant debate in elderly patients. This meta-analysis aims to estimate the effect perioperative continuous IV lidocaine in elderly patients undergoing surgery. Method Pubmed/Medline, Web of Science, Embase and CENTRAL through OVID SP were independently searched until November 1, 2019 by two authors. This systematic review and meta-analysis included all randomized controlled trials that compared the effect of continuous IV lidocaine and any placebo or no treatment in aged patients after surgery. Primary outcomes were length of hospital stay and postoperative pain score and second outcomes were postoperative nausea and vomiting, opioid consumption, gastrointestinal recovery and postoperative neuropsychological function status scale. Result Eighteen studies(1175 patients) were included. Meta-analysis suggested that IV lidocaine reduce the postoperative pain scores(visual analogue scale, 0-10cm) at 2h(SMD:-1.30, 95% CI -1.90 to -0.70), 4h(SMD:-1.20, 95% CI -1.91 to -0.49), 6h(SMD:-0.87, 95%CI -1.72 to 0.02), 8h(SMD:-0.84, 95%CI -1.40 to -0.27), 12h(SMD:-0.73, 95%CI -1.14 to -0.32), 24h(SMD:-0.39, 95%CI -0.66 to -0.11), shorten length of hospital stay(MD: -0.30, 95%CI -0.50 to -0.09), decrease the requirement of opioid drugs(SMD: -0.31, 95%CI -0.31 to -0.01) and the incidence of postoperative nausea(OR: 0.52, 95%CI 0.31 to 0.87) in elderly patients undergoing surgery. Conclusion The evidence suggested that IV lidocaine significantly reduce postoperative pain intensity and opioid consumption and shorten the length of hospital stay in aged patients. In addition, it was shown that IV lidocaine decrease the requirement of postoperative opioid and incidence of postoperative nausea compared to control group. IV lidocaine maybe a useful assistant during general anesthesia owing to its beneficial effect in several outcomes in geratic patients undergoing surgery.