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Efficacy of perioperative lidocaine infusion on surgical field quality during functional endoscopic sinus surgery: a systematic review and meta-analysis with trial sequential analysis

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Abstract

Purpose

To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) that assessed the efficacy of perioperative intravenous lidocaine versus placebo in improving the quality of surgical field during functional endoscopic sinus surgery (FESS).

Methods

PubMed, Scopus, Web of Science, and CENTRAL were thoroughly searched from inception until June 2023. The included RCTs were evaluated via RoB-2 tool. Our primary endpoint included intraoperative surgical field quality, and secondary endpoints involved operative duration, estimated blood loss, time for post-anesthesia care unit (PACU) discharge, postoperative pain, mean difference in heart rate (HR), and mean difference in mean arterial pressure (MAP). Continuous data were pooled as mean difference (MD) or standardized mean difference (SMD) via RevMan software. Also, the certainty of evidence for each outcome were assessed according to the GRADE system.

Results

Four RCTs with total of 267 patients were included. Regarding the intraoperative quality of surgical field, the results indicated a significant difference in favor of the lidocaine group compared to the placebo group (n = 3 RCTs, MD − 0.80, 95% CI [− 0.98, − 0.61], p < 0.001, moderate certainty of evidence). The trial sequential analysis showed there is a substantial and conclusive evidence. Regarding time for PACU discharge, there was a significant difference that favor lidocaine group (p < 0.05). On the contrary, there was no significant difference between lidocaine and placebo groups in terms of operative duration, estimated blood loss, postoperative pain, mean change in MAP and HR, (p > 0.05).

Conclusion

Our review revealed that lidocaine infusion, compared with a placebo, significantly improved the surgical field and shortened the time required for PACU discharge. However, lidocaine did not reduce surgery time, estimated blood loss, postoperative pain, MAP, or HR.

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Availability of data and materials

All data are available within the manuscript and its supplemental files.

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Authors and Affiliations

  1. Kuwait Institute for Medical Specializations (KIMS), Kuwait City, Kuwait

    Ebraheem Albazee & Mashael AlKandery

  2. Otorhinolaryngology-Head and Neck Surgery and Communication Sciences Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia

    Hemail M. Alsubaie

  3. Department of Otolaryngology-Head and Neck Surgery, Tallaght University Hospital, Dublin, Ireland

    Shawkat Abdulrahman

  4. Department of Otolaryngology-Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia

    Saad Alsaleh

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  3. Mashael AlKandery
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  4. Shawkat Abdulrahman
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  5. Saad Alsaleh
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Contributions

EA and HMA contributed to study conception, study design, data collection, data analysis, write up of original draft of manuscript, and review of manuscript for editorial and intellectual contents. MA contributed to literature review, data collection, and review of manuscript for editorial and intellectual contents. SA and SA contributed to supervision and review of manuscript for editorial and intellectual contents. All authors read and approved the final draft of manuscript.

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Correspondence to Ebraheem Albazee.

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Albazee, E., Alsubaie, H.M., AlKandery, M. et al. Efficacy of perioperative lidocaine infusion on surgical field quality during functional endoscopic sinus surgery: a systematic review and meta-analysis with trial sequential analysis. Eur Arch Otorhinolaryngol 281, 2819–2831 (2024). https://doi.org/10.1007/s00405-024-08455-w

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