Efficacy and safety of intravenous lidocaine for postoperative analgesia and recovery after surgery: a systematic review with trial sequential analysis

Weibel, Stephanie; Jokinen, Johanna; Pace, Nathan L.; Schnabel, Alexander; Hollmann, Markus W.; Hahnenkamp, Klaus; Eberhart, Leopold; Poepping, D.; Afshari, Arash; Kranke, Peter

doi:10.1093/bja/aew101

Cited by 206 publications

(116 citation statements)

References 68 publications

(79 reference statements)

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“…Previous studies suggested that IV lidocaine contributed to pain relief in patients after laparoscopic abdominal surgery at 24 hours, but the intervention group did not benefit from lidocaine administration compared with the placebo group at 48 hours. 29,30 A recent study, similar to ours, found that the lidocaine group had lower pain scores on movement, but there was no difference in the two groups at rest within 24 hours. 14 There are several reasons that could explain the lack of efficacy in decreasing pain scores at rest.…”

Section: Discussionsupporting

confidence: 66%

The effects of intravenous lidocaine on wound pain and gastrointestinal function recovery after laparoscopic colorectal surgery

Shi

Zhang

Wei‐wei

et al. 2019

International Wound Journal

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To evaluate the efficacy of intravenous lidocaine in relieving postoperative pain and promoting rehabilitation in laparoscopic colorectal surgery, we conducted this meta‐analysis. The systematic search strategy was performed on PubMed, EMBASE, Chinese databases, and Cochrane Library before September 2019. As a result, 10 randomised clinical trials were included in this meta‐analysis (n = 527 patients). Intravenous lidocaine significantly reduced pain scores at 2, 4, 12, 24, and 48 hours on movement and 2, 4, and 12 hours on resting‐state and reduced opioid requirement in first 24 hours postoperatively (weighted mean difference [WMD] = −5.02 [−9.34, −0.70]; P = .02). It also decreased the first flatus time (WMD: −10.15 [−11.20, −9.10]; P < .00001), first defecation time (WMD: −10.27 [−17.62, −2.92]; P = .006), length of hospital stay (WMD: −1.05 [−1.89, −0.21]; P = .01), and reduced the incidence of postoperative nausea and vomiting (risk ratio: 0.53 [0.30, 0.93]; P = .03) when compared with control group. However, it had no effect on pain scores at 24 and 48 hours at rest, the normal dietary time, and the level of serum C‐reactive protein. In summary, perioperative intravenous lidocaine could alleviate acute pain, reduce postoperative analgesic requirements, and accelerate recovery of gastrointestinal function in patients undergoing laparoscopic colorectal surgery.

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Section: Discussionsupporting

confidence: 66%

The effects of intravenous lidocaine on wound pain and gastrointestinal function recovery after laparoscopic colorectal surgery

Shi

Zhang

Wei‐wei

et al. 2019

International Wound Journal

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“…Pain relieving actions of blockade of nociceptive input arising from the periphery is clinically validated (e.g., local anesthetics), however this is not always possible in patients [96]. Additionally, inhibition of the physiological function of pain can be dangerous and can lead to bodily harm as seen in patients with congenital insensitivity to pain [21; 58].…”

Section: Pain In Discovery Researchmentioning

confidence: 99%

Reward, motivation, and emotion of pain and its relief

Porreca

Navratilova

2017

Pain

133

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The experience of pain depends on interpretation of context and past experience that guide the choice of an immediate behavioral response and influence future decisions of actions to avoid harm. The aversive qualities of pain underlie its physiological role in learning and motivation. In this review, we highlight findings from human and animal investigations that suggest that both pain, and the relief of pain, are complex emotions that are comprised of feelings and their motivational consequences. Relief of aversive states, including pain, is rewarding. How relief of pain aversiveness occurs is not well understood. Termination of aversive states can directly provide relief as well as reinforce behaviors that result in avoidance of pain. Emerging preclinical data also suggests that relief may elicit a positive hedonic value that results from activation of neural cortical and mesolimbic brain circuits that may also motivate behavior. Brain circuits mediating the reward of pain relief, as well as relief-induced motivation are significantly impacted as pain becomes chronic. In chronic pain states, the negative motivational value of nociception may be increased while the value of the reward of pain relief may decrease. As a consequence, the impact of pain on these ancient, and conserved brain limbic circuits suggest a path forward for discovery of new pain therapies.

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“…However, the addition of postoperative low-dose ketamine infusions in sub-anesthetic doses to parenteral hydromorphone has not been demonstrated to decrease postoperative opioid use (74–76). Other opioid-sparing intraoperative and postoperative strategies such as lidocaine and dexmedetomidine infusions are also potential options, but have not been rigorously studied in trials focusing on chronic opioid users (77)(78)(79). A discussion with the anesthesiologist may allow for optimal selection of adjunctive intraoperative agents, to improve postoperative pain control.…”

Section: Special Considerations In Patients With Chronic Opioid Use Omentioning

confidence: 99%

Perioperative pain management strategies among women having reproductive surgeries

Prabhu

Bortoletto

Bateman

2017

Fertility and Sterility

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In this review, we present opioid-sparing strategies for perioperative pain management among women undergoing reproductive surgeries and procedures. We provide recommendations regarding the use of nonsteroidal anti-inflammatory drugs, acetaminophen, other adjunctive medications, and regional anesthetic blocks. We discuss additional considerations for chronic opioid users or patients using opioid replacement or antagonist therapy.

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Efficacy and safety of intravenous lidocaine for postoperative analgesia and recovery after surgery: a systematic review with trial sequential analysis

Abstract: There is limited evidence suggesting that i.v. lidocaine may be a useful adjuvant during general anaesthesia because of its beneficial impact on several outcomes after surgery.

Cited by 206 publications

References 68 publications

The effects of intravenous lidocaine on wound pain and gastrointestinal function recovery after laparoscopic colorectal surgery

The effects of intravenous lidocaine on wound pain and gastrointestinal function recovery after laparoscopic colorectal surgery

Reward, motivation, and emotion of pain and its relief

Perioperative pain management strategies among women having reproductive surgeries

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