Effect of perioperative intravenous lidocaine for patients undergoing spine surgery

Abstract

Background: Perioperative intravenous lidocaine has been reported to have analgesic and opioid-sparing effects in many kinds of surgery. Several studies have evaluated its use in the settings of spine surgery. The aim of the study is to examine the effect of intravenous lidocaine in patients undergoing spine surgery. Methods: We performed a quantitative systematic review. Databases of PubMed, Medline, Embase database and Cochrane library were investigated for eligible literatures from their establishments to June, 2019. Articles of randomized controlled trials that compared intravenous lidocaine to a control group in patients undergoing spine surgery were included. The primary outcome was postoperative pain intensity. Secondary outcomes included postoperative opioid consumption and the length of hospital stay. Result: Four randomized controlled trials with 275 patients were included in the study. postoperative pain compared with control was reduced at 6 hours after surgery (WMD −0.50, 95%CI, −0.76 to −0.25, P < .001), at 24 hours after surgery (WMD −0.50, 95%CI, −0.70 to −0.29, P < .001) and at 48 hours after surgery (WMD −0.57, 95%CI, −0.96 to −0.17, P = .005). The effect of intravenous lidocaine on postoperative opioid consumption compared with control revealed a significant effect (WMD −15.36, 95%CI, −21.40 to −9.33 mg intravenous morphine equivalents, P < .001). Conclusion: This quantitative analysis of randomized controlled trials demonstrated that the perioperative intravenous lidocaine was effective for reducing postoperative opioid consumption and pain in patients undergoing spine surgery. The intravenous lidocaine should be considered as an effective adjunct to improve analgesic outcomes in patients undergoing spine surgery. However, the quantity of the studies was very low, more research is needed.

Management of Postoperative Pain in Patients Following Spine Surgery: A Narrative Review

“…Opioid consumption was decreased in the first 24 hours and 48 hours after surgery among those receiving IV lidocaine. 102 Given the limited number of studies to date, 125 more research is needed to confirm these findings, and to examine the remote effects of IV lidocaine months after spine surgery including the development of persistent postsurgical pain. Compared to placebo, elderly patients receiving IV lidocaine for spine surgery demonstrate significantly better cognitive function three days after surgery, and these findings warrant further investigation of IV lidocaine's neuroprotective effects.…”

Postoperative analgesia for complex spinal surgery

“…lidocaine infusion was associated with reduced pain intensity at 6, 24 and 48 h after spinal surgery and reduced postoperative opioid requirement. There was high heterogeneity among the included trials with regards to opioid requirement, which was reduced significantly by removing one study [33] which utilized a lower infusion dose of 1.5 mg/kg/h compared to 2 mg/kg/h by the three other studies, suggesting a dose dependent effect [32 ▪ ,33]. Another meta-analysis of 10 studies included the studies analyzed by Bi et al [32 ▪ ] but did not find significant difference in opioid requirement.…”

“…There was high heterogeneity among the included trials with regards to opioid requirement, which was reduced significantly by removing one study [33] which utilized a lower infusion dose of 1.5 mg/kg/h compared to 2 mg/kg/h by the three other studies, suggesting a dose dependent effect [32 ▪ ,33]. Another meta-analysis of 10 studies included the studies analyzed by Bi et al [32 ▪ ] but did not find significant difference in opioid requirement. However, they found significantly improved pain scores in the lidocaine group [34 ▪ ].…”

“…A systematic review by Bi et al [32 ▪ ] showed that perioperative i.v. lidocaine infusion was associated with reduced pain intensity at 6, 24 and 48 h after spinal surgery and reduced postoperative opioid requirement.…”

Lidocaine, old drug - new possibilities. Treatment of postoperative pain and reduction of postoperative complications with intravenous administration

“…Zmniejszyła się także ilość przyjmowanych opioidów (WMD -15.36, 95%CI, -21.40 to -9.33 mg, P < .001). Zaleca się więc stosowanie IVL podczas zabiegów kręgosłupa [40].…”