Continuous intravenous perioperative lidocaine infusion for postoperative pain and recovery in adults

The management of postoperative pain and recovery is still unsatisfactory in a number of cases in clinical practice. Opioids used for postoperative analgesia are frequently associated with adverse effects, including nausea and constipation, preventing smooth postoperative recovery. Not all patients...

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Published in:	Cochrane database of systematic reviews 2018-06, Vol.6 (6), p.CD009642
Main Authors:	Weibel, Stephanie, Jelting, Yvonne, Pace, Nathan L, Helf, Antonia, Eberhart, Leopold Hj, Hahnenkamp, Klaus, Hollmann, Markus W, Poepping, Daniel M, Schnabel, Alexander, Kranke, Peter
Format:	Article
Language:	eng
Subjects:	Analgesia, Epidural Analgesics, Opioid - therapeutic use Anesthetics, Intravenous - administration & dosage Anesthetics, Intravenous - adverse effects Anesthetics, Local - administration & dosage Anesthetics, Local - adverse effects Humans Ileus - epidemiology Lidocaine - administration & dosage Lidocaine - adverse effects Nausea - epidemiology Pain & anaesthesia Pain management Pain Measurement Pain, Postoperative - drug therapy Postoperative Complications - epidemiology Randomized Controlled Trials as Topic Recovery of Function
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Summary:	The management of postoperative pain and recovery is still unsatisfactory in a number of cases in clinical practice. Opioids used for postoperative analgesia are frequently associated with adverse effects, including nausea and constipation, preventing smooth postoperative recovery. Not all patients are suitable for, and benefit from, epidural analgesia that is used to improve postoperative recovery. The non-opioid, lidocaine, was investigated in several studies for its use in multimodal management strategies to reduce postoperative pain and enhance recovery. This review was published in 2015 and updated in January 2017. To assess the effects (benefits and risks) of perioperative intravenous (IV) lidocaine infusion compared to placebo/no treatment or compared to epidural analgesia on postoperative pain and recovery in adults undergoing various surgical procedures. We searched CENTRAL, MEDLINE, Embase, CINAHL, and reference lists of articles in January 2017. We searched one trial registry contacted researchers in the field, and handsearched journals and congress proceedings. We updated this search in February 2018, but have not yet incorporated these results into the review. We included randomized controlled trials comparing the effect of continuous perioperative IV lidocaine infusion either with placebo, or no treatment, or with thoracic epidural analgesia (TEA) in adults undergoing elective or urgent surgery under general anaesthesia. The IV lidocaine infusion must have been started intraoperatively, prior to incision, and continued at least until the end of surgery. We used Cochrane's standard methodological procedures. Our primary outcomes were: pain score at rest; gastrointestinal recovery and adverse events. Secondary outcomes included: postoperative nausea and postoperative opioid consumption. We used GRADE to assess the quality of evidence for each outcome. We included 23 new trials in the update. In total, the review included 68 trials (4525 randomized participants). Two trials compared IV lidocaine with TEA. In all remaining trials, placebo or no treatment was used as a comparator. Trials involved participants undergoing open abdominal (22), laparoscopic abdominal (20), or various other surgical procedures (26). The application scheme of systemic lidocaine strongly varies between the studies related to both dose (1 mg/kg/h to 5 mg/kg/h) and termination of the infusion (from the end of surgery until several days after).The risk of bias was low with
ISSN:	1469-493X