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


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Article Info

DATE

2010-11-09

AUTHORS

Louise Vigneault, Alexis F. Turgeon, Dany Côté, François Lauzier, Ryan Zarychanski, Lynne Moore, Lauralyn A. McIntyre, Pierre C. Nicole, Dean A. Fergusson

ABSTRACT

IntroductionVarious 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.MethodsA systematic search was performed using MEDLINE, 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 I2 index.ResultsFrom 5,472 citations retrieved, 29 studies involving a total of 1,754 patients met eligibility. At six hours postoperatively, intravenous lidocaine infusion reduced pain at rest (weighted mean difference [WMD] −8.70, 95% confidence intervals [CI] −16.19 to −1.21), during cough (WMD −11.19, 95% CI −17.73 to −4.65), and during movement (WMD −9.56, 95% CI −17.31 to −1.80). Intravenous lidocaine infusion also reduced opioid requirement (morphine) (WMD −8.44 mg, 95% CI −11.32 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 incidence of cardiac and neurologic adverse events was comparable. Eight studies observed toxic plasma levels.DiscussionPerioperative 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. More... »

PAGES

22-37

Journal

TITLE

Journal canadien d'anesthésie

ISSUE

1

VOLUME

58

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  • High Dose Intravenous Lidocaine Vs Hydromorphone For Acute Abdominal Pain In The Emergency Department: A Randomized, Comparative Efficacy Trial
  • The Effect Of Lidocaine To Prevent The Development Of Chronic Post-Surgical Pain
  • Identifiers

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    http://scigraph.springernature.com/pub.10.1007/s12630-010-9407-0

    DOI

    http://dx.doi.org/10.1007/s12630-010-9407-0

    DIMENSIONS

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    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/21061107


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        "description": "IntroductionVarious 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.MethodsA systematic search was performed using MEDLINE, 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 I2 index.ResultsFrom 5,472 citations retrieved, 29 studies involving a total of 1,754 patients met eligibility. At six hours postoperatively, intravenous lidocaine infusion reduced pain at rest (weighted mean difference [WMD] \u22128.70, 95% confidence intervals [CI] \u221216.19 to \u22121.21), during cough (WMD \u221211.19, 95% CI \u221217.73 to \u22124.65), and during movement (WMD \u22129.56, 95% CI \u221217.31 to \u22121.80). Intravenous lidocaine infusion also reduced opioid requirement (morphine) (WMD \u22128.44\u00a0mg, 95% CI \u221211.32 to \u22125.56), time to first flatus (WMD \u22127.62\u00a0hr, 95% CI \u221210.78 to \u22124.45), time to first feces (WMD \u221210.71\u00a0hr, 95% CI \u221216.14 to \u22125.28), nausea/vomiting (risk ratios\u00a0=\u00a00.71, 95% CI 0.57-0.90), and hospital length of stay (WMD \u22120.17 days, 95% CI \u22120.41 to 0.07). Abdominal surgery was strongly associated with benefit. For the 12 studies that systematically screened adverse events, the incidence of cardiac and neurologic adverse events was comparable. Eight studies observed toxic plasma levels.DiscussionPerioperative 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.", 
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    20 schema:description IntroductionVarious 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.MethodsA systematic search was performed using MEDLINE, 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 I2 index.ResultsFrom 5,472 citations retrieved, 29 studies involving a total of 1,754 patients met eligibility. At six hours postoperatively, intravenous lidocaine infusion reduced pain at rest (weighted mean difference [WMD] −8.70, 95% confidence intervals [CI] −16.19 to −1.21), during cough (WMD −11.19, 95% CI −17.73 to −4.65), and during movement (WMD −9.56, 95% CI −17.31 to −1.80). Intravenous lidocaine infusion also reduced opioid requirement (morphine) (WMD −8.44 mg, 95% CI −11.32 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 incidence of cardiac and neurologic adverse events was comparable. Eight studies observed toxic plasma levels.DiscussionPerioperative 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.
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    28 DiscussionPerioperative IVLI
    29 EMBASE
    30 I2 index
    31 IntroductionVarious strategies
    32 MEDLINE
    33 MethodsA systematic search
    34 ResultsFrom
    35 Scopus databases
    36 Secondary outcomes
    37 abdominal surgery
    38 abdominal surgery populations
    39 adverse events
    40 analgesic efficacy
    41 anesthesia
    42 benefits
    43 citations
    44 clinical benefit
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    46 control
    47 cough
    48 database
    49 dose
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    72 levels
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    77 most studies
    78 movement
    79 nausea/vomiting
    80 neurologic adverse events
    81 opioid requirements
    82 outcomes
    83 pain
    84 pain control
    85 patients
    86 perioperative intravenous lidocaine infusion
    87 placebo
    88 plasma levels
    89 population
    90 postoperative pain
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    92 primary outcome
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    94 recovery time
    95 requirements
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