World Journal of Surgery

, Volume 39, Issue 9, pp 2220–2234 | Cite as

Efficacy of Intravenous Lidocaine for Postoperative Analgesia Following Laparoscopic Surgery: A Meta-Analysis

  • Nicholas T. Ventham
  • Ewan D. Kennedy
  • Richard R. Brady
  • Hugh M. Paterson
  • Doug Speake
  • Irwin Foo
  • Kenneth C.  H.  Fearon
Original Scientific Report

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Supplementary material

268_2015_3105_MOESM1_ESM.pdf (88 kb)
Supplementary material 1 (PDF 88 kb)
268_2015_3105_MOESM2_ESM.pdf (1.3 mb)
Supplementary material 2 (PDF 1301 kb)

References

  1. 1.
    Møiniche S, Mikkelsen S, Wetterslev J, Dahl JB (1998) A qualitative systematic review of incisional local anaesthesia for postoperative pain relief after abdominal operations. Br J Anaesth 81:377–383PubMedCrossRefGoogle Scholar
  2. 2.
    Rafi AN (2001) Abdominal field block: a new approach via the lumbar triangle. Anaesthesia 56:1024–1026PubMedCrossRefGoogle Scholar
  3. 3.
    Johns N, O’Neill S, Ventham NT et al (2012) Clinical effectiveness of transversus abdominis plane (TAP) block in abdominal surgery: a systematic review and meta-analysis. Colorectal Dis 14:e635–e642PubMedCrossRefGoogle Scholar
  4. 4.
    Ventham NT, Hughes M, O’Neill S et al (2013) Systematic review and meta-analysis of continuous local anaesthetic wound infiltration versus epidural analgesia for postoperative pain following abdominal surgery. Br J Surg 100:1280–1289PubMedCrossRefGoogle Scholar
  5. 5.
    Ventham NT, O’Neill S, Johns N et al (2014) Evaluation of novel local anesthetic wound infiltration techniques for postoperative pain following colorectal resection surgery: a meta-analysis. Dis Colon Rectum 57:237–250PubMedCrossRefGoogle Scholar
  6. 6.
    Groudine S (2014) Transversus abdominis plane blocks and systemic absorption. Anesth Analg 119:1002PubMedCrossRefGoogle Scholar
  7. 7.
    Latzke D, Marhofer P, Kettner SC et al (2012) Pharmacokinetics of the local anesthetic ropivacaine after transversus abdominis plane block in healthy volunteers. Eur J Clin Pharmacol 68:419–425PubMedCrossRefGoogle Scholar
  8. 8.
    Griffiths JD, Barron FA, Grant S et al (2010) Plasma ropivacaine concentrations after ultrasound-guided transversus abdominis plane block. Br J Anaesth 105:853–856PubMedCrossRefGoogle Scholar
  9. 9.
    Keats AS, D’Alessandro GL, Beecher HK (1951) Controlled study of pain relief by intravenous procaine. J Am Med Assoc 147:1761–1763PubMedCrossRefGoogle Scholar
  10. 10.
    Bartlett EE, Hutserani O (1961) Xylocaine for the relief of postoperative pain. Anesth Analg 40:296–304PubMedCrossRefGoogle Scholar
  11. 11.
    Kawamata M, Takahashi T, Kozuka Y et al (2002) Experimental incision-induced pain in human skin: effects of systemic lidocaine on flare formation and hyperalgesia. Pain 100:77–89PubMedCrossRefGoogle Scholar
  12. 12.
    Wu CL, Liu SS (2009) Intravenous lidocaine for ambulatory anesthesia: good to go or not so fast? Anesth Analg 109:1718–1719PubMedCrossRefGoogle Scholar
  13. 13.
    Jänig W (2008) What is the mechanism underlying treatment of pain by systemic application of lidocaine? Pain 137:5–6PubMedCrossRefGoogle Scholar
  14. 14.
    Tanelian DL, MacIver MB (1991) Analgesic concentrations of lidocaine suppress tonic A-delta and C fiber discharges produced by acute injury. Anesthesiology 74:934–936PubMedCrossRefGoogle Scholar
  15. 15.
    Koppert W, Ostermeier N, Sittl R et al (2000) Low-dose lidocaine reduces secondary hyperalgesia by a central mode of action. Pain 85:217–224PubMedCrossRefGoogle Scholar
  16. 16.
    Hollmann MW, Durieux ME (2000) Local anesthetics and the inflammatory response: a new therapeutic indication? Anesthesiology 93:858–875PubMedCrossRefGoogle Scholar
  17. 17.
    Herroeder S, Pecher S, Schönherr ME et al (2007) Systemic lidocaine shortens length of hospital stay after colorectal surgery: a double-blinded, randomized, placebo-controlled trial. Ann Surg 246:192–200PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Marret E, Rolin M, Beaussier M, Bonnet F (2008) Meta-analysis of intravenous lidocaine and postoperative recovery after abdominal surgery. Br J Surg 95:1331–1338PubMedCrossRefGoogle Scholar
  19. 19.
    Sun Y, Li T, Wang N et al (2012) Perioperative systemic lidocaine for postoperative analgesia and recovery after abdominal surgery: a meta-analysis of randomized controlled trials. Dis Colon Rectum 55:1183–1194PubMedCrossRefGoogle Scholar
  20. 20.
    McCarthy GC, Megalla SA, Habib AS (2010) Impact of intravenous lidocaine infusion on postoperative analgesia and recovery from surgery: a systematic review of randomized controlled trials. Drugs 70:1149–1163PubMedCrossRefGoogle Scholar
  21. 21.
    Vigneault L, Turgeon AF, Côté D et al (2011) Perioperative intravenous lidocaine infusion for postoperative pain control: a meta-analysis of randomized controlled trials. Can J Anaesth 58:22–37PubMedCrossRefGoogle Scholar
  22. 22.
    Fearon KCH, Ljungqvist O, Von Meyenfeldt M et al (2005) Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr 24:466–477PubMedCrossRefGoogle Scholar
  23. 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. 24.
    Woodbury G (2002) Chapter 5. Normal probability distributions. In: An Introduction to statistics, 1st edn. Cengage Learning, p 254Google Scholar
  25. 25.
    Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Silvasti M, Rosenberg P, Seppälä T et al (1998) Comparison of analgesic efficacy of oxycodone and morphine in postoperative intravenous patient-controlled analgesia. Acta Anaesthesiol Scand 42:576–580PubMedCrossRefGoogle Scholar
  27. 27.
    Pereira J, Lawlor P, Vigano A et al (2001) Equianalgesic dose ratios for opioids. a critical review and proposals for long-term dosing. J Pain Symptom Manage 22:672–687PubMedCrossRefGoogle Scholar
  28. 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
  29. 29.
    Chalmers TC, Smith H, Blackburn B et al (1981) A method for assessing the quality of a randomized control trial. Control Clin Trials 2:31–49PubMedCrossRefGoogle Scholar
  30. 30.
    Jadad AR, Moore RA, Carroll D et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12PubMedCrossRefGoogle Scholar
  31. 31.
    Viechtbauer W (2010) Conducting meta-analyses in R with the metafor package. J Stat Softw 36:1–48Google Scholar
  32. 32.
    Wu CT, Borel CO, Lee MS et al (2005) The interaction effect of perioperative cotreatment with dextromethorphan and intravenous lidocaine on pain relief and recovery of bowel function after laparoscopic cholecystectomy. Anesth Analg 100:448–453PubMedCrossRefGoogle Scholar
  33. 33.
    Lauwick S, Kim DJ, Michelagnoli G et al (2008) Intraoperative infusion of lidocaine reduces postoperative fentanyl requirements in patients undergoing laparoscopic cholecystectomy. Can J Anaesth 55:754–760PubMedCrossRefGoogle Scholar
  34. 34.
    Saadawy IM, Kaki AM, Abd El Latif aa et al (2010) Lidocaine vs. magnesium: effect on analgesia after a laparoscopic cholecystectomy. Acta Anaesthesiol Scand 54:549–556PubMedCrossRefGoogle Scholar
  35. 35.
    Yang SY, Kang H, Choi GJ et al (2014) Efficacy of intraperitoneal and intravenous lidocaine on pain relief after laparoscopic cholecystectomy. J Int Med Res 42:307–319PubMedCrossRefGoogle Scholar
  36. 36.
    Kaba A, Laurent SR, Detroz BJ et al (2007) Intravenous lidocaine infusion facilitates acute rehabilitation after laparoscopic colectomy. Anesthesiology 106:11–16PubMedCrossRefGoogle Scholar
  37. 37.
    Kim HO, Lee SR, Choi WJ (2014) Early oral feeding following laparoscopic colorectal cancer surgery. ANZ J Surg 84:539–544PubMedCrossRefGoogle Scholar
  38. 38.
    Tikuisis R, Miliauskas P, Samalavicius NE et al (2014) Intravenous lidocaine for post-operative pain relief after hand-assisted laparoscopic colon surgery: a randomized, placebo-controlled clinical trial. Tech Coloproctol 18:373–380PubMedCentralPubMedCrossRefGoogle Scholar
  39. 39.
    Grady P, Clark N, Lenahan J et al (2012) Effect of intraoperative intravenous lidocaine on postoperative pain and return of bowel function after laparoscopic abdominal gynecologic procedures. AANA J 80:282–288PubMedGoogle Scholar
  40. 40.
    De Oliveira GSJ, Fitzgerald P, Streicher LF et al (2012) Systemic lidocaine to improve postoperative quality of recovery after ambulatory laparoscopic surgery. Anesth Analg 115:262–267PubMedCrossRefGoogle Scholar
  41. 41.
    Lauwick S, Kim DJ, Mistraletti G, Carli F (2009) Functional walking capacity as an outcome measure of laparoscopic prostatectomy: the effect of lidocaine infusion. Br J Anaesth 103:213–219PubMedCrossRefGoogle Scholar
  42. 42.
    Wuethrich PY, Romero J, Burkhard FC, Curatolo M (2012) No benefit from perioperative intravenous lidocaine in laparoscopic renal surgery: a randomised, placebo-controlled study. Eur J Anaesthesiol 29:537–543PubMedCrossRefGoogle Scholar
  43. 43.
    Kim TH, Kang H, Hong JH et al (2011) Intraperitoneal and intravenous lidocaine for effective pain relief after laparoscopic appendectomy: a prospective, randomized, double-blind, placebo-controlled study. Surg Endosc 25:3183–3190PubMedCrossRefGoogle Scholar
  44. 44.
    Kim TH, Kang H, Choi YS et al (2013) Pre- and intraoperative lidocaine injection for preemptive analgesics in laparoscopic gastrectomy: a prospective, randomized, double-blind, placebo-controlled study. J Laparoendosc Adv Surg Tech A 23:663–668PubMedCrossRefGoogle Scholar
  45. 45.
    Ram D, Sistla SC, Karthikeyan VS et al (2014) Comparison of intravenous and intraperitoneal lignocaine for pain relief following laparoscopic cholecystectomy: a double-blind, randomized, clinical trial. Surg Endosc 28:1291–1297PubMedCrossRefGoogle Scholar
  46. 46.
    Cepeda MS, Africano JM, Polo R et al (2003) What decline in pain intensity is meaningful to patients with acute pain? Pain 105:151–157PubMedCrossRefGoogle Scholar
  47. 47.
    Gray A, Kehlet H, Bonnet F, Rawal N (2005) Predicting postoperative analgesia outcomes: NNT league tables or procedure-specific evidence? Br J Anaesth 94:710–714PubMedCrossRefGoogle Scholar
  48. 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
  49. 49.
    Paddison JS, Booth RJ, Fuchs D, Hill AG (2008) Peritoneal inflammation and fatigue experiences following colorectal surgery: a pilot study. Psychoneuroendocrinology 33:446–454PubMedCrossRefGoogle Scholar
  50. 50.
    Sammour T, Kahokehr A, Soop M, Hill AG (2010) Peritoneal damage: the inflammatory response and clinical implications of the neuro-immuno-humoral axis. World J Surg 34:704–720. doi:10.1007/s00268-009-0382-y PubMedCrossRefGoogle Scholar
  51. 51.
    Dorian P, Cass D, Schwartz B et al (2002) Amiodarone as compared with lidocaine for shock-resistant ventricular fibrillation. N Engl J Med 346:884–890PubMedCrossRefGoogle Scholar
  52. 52.
    The Resus Council (2010) 2010 Resuscitation Guidelines. 177Google Scholar
  53. 53.
    Cox B, Durieux ME, Marcus MAE (2003) Toxicity of local anaesthetics. Best Pract Res Clin Anaesthesiol 17:111–136PubMedCrossRefGoogle Scholar
  54. 54.
    Groudine SB, Fisher HA, Kaufman RP et al (1998) Intravenous lidocaine speeds the return of bowel function, decreases postoperative pain, and shortens hospital stay in patients undergoing radical retropubic prostatectomy. Anesth Analg 86:235–239PubMedGoogle Scholar
  55. 55.
    Koppert W, Weigand M, Neumann F et al (2004) Perioperative intravenous lidocaine has preventive effects on postoperative pain and morphine consumption after major abdominal surgery. Anesth Analg 98:1050–1055PubMedCrossRefGoogle Scholar
  56. 56.
    Griffin EM, Prystowsky H, HIingson RA (1951) The use of topical anaesthesia of the peritoneum in poor risk surgery and in augmenting inadequate vertebral conduction anaesthesia. N Z Med J 50:31–33PubMedGoogle Scholar
  57. 57.
    Fuhrer Y, Charpentier C, Boulanger G et al (1996) Analgesia after laparoscopic cholecystectomy by intraperitoneal administration of bupivacaine. Ann Fr Anesth Reanim 15:128–134PubMedCrossRefGoogle Scholar
  58. 58.
    Kahokehr A (2013) Intraperitoneal local anesthetic for postoperative pain. Saudi J Anaesth 7:5PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2015

Authors and Affiliations

  • Nicholas T. Ventham
    • 1
  • Ewan D. Kennedy
    • 1
  • Richard R. Brady
    • 1
  • Hugh M. Paterson
    • 1
  • Doug Speake
    • 1
  • Irwin Foo
    • 2
  • Kenneth C.  H.  Fearon
    • 1
  1. 1.Department of Colorectal SurgeryWestern General HospitalEdinburghUK
  2. 2.Department of AnaesthesiaWestern General HospitalEdinburghUK

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