Perioperative Systemic Lidocaine for Postoperative Analgesia and Recovery after Abdominal Surgery: A Meta-analysis of Randomized Controlled Trials


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Abstract

BACKGROUND:Postoperative pain management remains a significant challenge after abdominal surgery.OBJECTIVE:The aim of this meta-analysis was to evaluate the efficacy of systemic lidocaine for postoperative pain management and recovery after abdominal surgery.DATA SOURCE:Data were derived from Medline (1966–2010), CINAHL, The Cochrane Central Register of Controlled Trials, and Scopus.STUDY SELECTION:Randomized controlled trials of systemic administration of lidocaine for postoperative analgesia and recovery after abdominal surgery in adults, ie, >18 years, were considered.INTERVENTIONS:Combined data were analyzed with use of a random-effects model.MAIN OUTCOMES MEASURES:Data on opioid consumption, postoperative pain intensity, opioid-related side effects, time to first flatus, time to first bowel movement, and length of hospital stay were extracted.RESULTS:Twenty-one trials comparing systemic lidocaine with placebo or blank control for postoperative analgesia and recovery after abdominal surgery were included in this meta-analysis. Weighted mean difference for cumulative analgesic opioid (morphine) consumption 48 hours after surgery was –7.04 mg (95% CI: –10.40, –3.68, I2 = 46.1%).Systemic lidocaine also significantly reduced postoperative pain intensity(visual analog scale, 0–100 mm) 6 hours after surgery at rest (weighted mean difference: –8.07 mm (95% CI: –14.69, –1.49); I2 = 90.6%) and during activity (weighted mean difference: –10.56 mm (95% CI: –16.89, –4.23), I2 = 82%). The time to first flatus and bowel movement was significantly shortened with lidocaine intervention by 6.92 hours (95% CI: –9.21, –4.63, I2 = 62.8%) and 11.74 hours (95% CI:–16.97, –6.51, I2 = 0). Moreover, systemic lidocaine also reduced hospital length of stay following the open procedure (weighted mean difference: –0.71 days (95% CI: –1.35, –0.07); I2 = 37.3%).LIMITATIONS:Heterogeneity of study results is the main limitation of this meta-analysis.CONCLUSION:Perioperative systemic lidocaine may be a useful adjunct for postoperative pain management by decreasing postoperative pain intensity, reducing opioid consumption, facilitating GI function, and shortening length of hospital stay.

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