Efficacy of Intravenous Lidocaine for Postoperative Analgesia Following Laparoscopic Surgery: A Meta-Analysis
Intravenous (IV) lidocaine has analgesic and anti-inflammatory properties. This study aims to evaluate the efficacy of IV lidocaine in controlling postoperative pain following laparoscopic surgery.
A meta-analysis of randomised controlled trials (RCTs) comparing IV lidocaine versus placebo/routine treatment for postoperative analgesia following laparoscopic surgery. The primary outcome was opiate requirement at 24 h. Secondary outcomes included cumulative opiate requirement, numerical pain scores (2, 12, 24, 48 h at rest and on movement), recovery indices (nausea and vomiting, length of stay, time until diet resumption, first flatus and bowel movement) and side effects (cardiac/neurological toxicity). Subgroup analyses were performed according to operation type and to compare IV lidocaine with intraperitoneal lidocaine.
Fourteen RCTs with 742 patients were included. IV lidocaine was associated with a small but significant reduction in opiate requirement at 24 h compared with placebo/routine care. IV lidocaine was associated with reduced cumulative opiate requirement, reduced pain scores at rest at 2, 12 and 24 h, reduced nausea and vomiting and a shorter time until resumption of diet. The length of stay did not differ between groups. There was a low incidence of IV lidocaine-associated toxicity. In subgroup analyses, there was no difference between IV and intraperitoneal lidocaine in the measured outcomes.
IV lidocaine has a multidimensional effect on the quality of recovery. IV lidocaine was associated with lower opiate requirements, reduced nausea and vomiting and a shorter time until resumption of diet. Whilst IV lidocaine appears safe, the optimal treatment regimen remains unknown. Statistical heterogeneity was high.
- 23.Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 339:6Google Scholar
- 24.Woodbury G (2002) Chapter 5. Normal probability distributions. In: An Introduction to statistics, 1st edn. Cengage Learning, p 254Google Scholar
- 28.UK Medicines Information pharmacists for NHS healthcare Professionals (UKMi) (2011) What are the equivalent doses of oral morphine to other oral opioids when used as analgesics in adult palliative care? http://www.surreyandsussex.nhs.uk/wp-content/uploads/2013/04/UKMi-Equivalent-doses-of-Oral-Morphine-to-other-Oral-Opioids-in-adult-Palliative-Care.pdf. Accessed 1 Dec 2014
- 31.Viechtbauer W (2010) Conducting meta-analyses in R with the metafor package. J Stat Softw 36:1–48Google Scholar
- 48.Wall PD, Melzack R (1999) Pain measurements in persons in pain. In: Wall PD, Melzack R (eds) Textbook of Pain, 4th edn. Churchill Livingstone, EdinburghGoogle Scholar
- 52.The Resus Council (2010) 2010 Resuscitation Guidelines. 177Google Scholar