Efficacy of intraoperative intravenous lidocaine for postoperative analgesia following bariatric surgery: a meta-analysis of randomized controlled studies

Hung, Kuo‐Chuan; Chang, Ying-Jen; Chen, I‐Wen; Chang, Yang‐Pei; Chiu, Sheng‐Fu; Sun, Cheuk‐Kwan

doi:10.1016/j.soard.2021.08.014

Cited by 11 publications

(11 citation statements)

References 59 publications

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“…A meta-analysis has highlighted the advantages of intraoperative intravenous lidocaine, notably in decreasing the time to first opioid requirement and improving recovery quality, although it did not significantly impact postoperative pain scores at 24 h [59]. Our study finds that lidocaine is highly effective in the early postoperative period, specifically within the 1st hour after surgery, and again later, between 6 to 12 h post-surgery.…”

Section: Discussionmentioning

confidence: 54%

“…Various meta-analyses have shown the effectiveness of drugs like NSAIDs [53], acetaminophen (or paracetamol) [54], ketamine [55], dexmedetomidine [56,57], clonidine [58], lidocaine [59], and magnesium [60,61], though not conclusively in obese patients [62], and preoperative oral gabapentinoids [63] in providing opioid-sparing analgesia. These medications have been effective in improving postoperative pain relief [53][54][55][56][57][58][59][60][61][62][63], reducing PONV [53,[55][56][57][58]63], and enhancing recovery quality in obese patients undergoing surgery [53][54][55][56][57][58][59][60][61][62][63].…”

Section: Discussionmentioning

confidence: 99%

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Non-Opioid Analgesics and Adjuvants after Surgery in Adults with Obesity: Systematic Review with Network Meta-Analysis of Randomized Controlled Trials

Carron,

Tamburini,

Linassi

et al. 2024

JCM

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Managing postoperative pain in patients with obesity is challenging. Although using a combination of pain relief methods is recommended for these patients, the true effectiveness of various intravenous non-opioid analgesics and adjuvants in multimodal anesthesia needs to be better defined. Methods: A systematic review and network meta-analysis was performed to evaluate the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, ketamine, α-2 agonists, lidocaine, magnesium, and oral gabapentinoids in adult surgical patients with obesity. The analysis aimed to compare these treatments to a placebo/no treatment or alternative analgesics, with a primary focus on postoperative pain and secondary endpoints including rescue analgesia, postoperative nausea and vomiting (PONV), and recovery quality. English-language randomized controlled trials across PubMed, Scopus, Web of Science, CINAHL, and EMBASE were considered. Quality and evidence certainty were assessed with the RoB 2 tool and GRADE, and data was analyzed with R software. Results: NSAIDs, along with acetaminophen, lidocaine, α-2 agonists, ketamine, and oral gabapentinoids, effectively reduce early postoperative pain. NSAIDs, particularly ibuprofen, as well as acetaminophen, ketamine, and lidocaine, also show benefits in later postoperative stages. Intravenous non-opioid analgesics and adjuvants show some degree of benefit in reducing PONV and the need for rescue analgesic therapy when using α-2 agonists alone or combined with oral gabapentinoids, notably decreasing the likelihood of PONV. Ketamine, lidocaine, and α-2 agonists are shown to enhance postoperative recovery and care quality. Conclusions: Intravenous non-opioid analgesics and adjuvants are valuable in multimodal anesthesia for pain management in adult surgical patients suffering from obesity.

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Non-Opioid Analgesics and Adjuvants after Surgery in Adults with Obesity: Systematic Review with Network Meta-Analysis of Randomized Controlled Trials

Carron,

Tamburini,

Linassi

et al. 2024

JCM

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“…Other components in pain management and treatment of endometriosis are the continuous intraoperative and postoperative administration of Dexmedetomidine and Lidocaine in patients at high risk for development and persistence of CPSP. Since many years, the highly selective alpha-2 Agonist has been established in postoperative pain therapy and many other indications [23,24]. Among others, these drugs have a place as co-anaesthetics in the perioperative setting [25] .…”

Section: Duringmentioning

confidence: 99%

Endometriosis: Where are we today? An Anesthesiologist’s Point of View

Vetter¹

2023

J Biomed Res Environ Sci

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“…Lidocaine is commonly used as a local anesthetic drug and is also administered intravenously in laparoscopic bariatric surgery [11,12]. Continuous infusion of lidocaine during surgery has shown promise in reducing intraoperative and postoperative pain, leading to decreased opioid consumption and improved postoperative recovery for patients with obesity undergoing bariatric surgery [11,13,14]. Nevertheless, there is limited pharmacokinetic information on lidocaine in obese patients, which hinders the establishment of standard treatment guidelines to accommodate the substantial increase in the number of bariatric surgeries.…”

Section: Introductionmentioning

confidence: 99%

Pharmacokinetics of lidocaine and its active metabolites in patients with obesity undergoing laparoscopic bariatric surgery: A prospective clinical study

Zhang,

Jin,

Yuan

et al. 2023

Preprint

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Purpose Lidocaine is widely used in laparoscopic bariatric surgery for obese patients. However, the impact of obesity on the pharmacokinetics of lidocaine and its metabolites is still unclear. This study aimed to compare the pharmacokinetics of lidocaine and its active metabolites in patients with obesity and normal-weight patients after a single lidocaine intravenous administration during surgery. Methods Sixty patients were enrolled in this study, including thirty patients with obesity undergoing laparoscopic sleeve gastrectomy and thirty normal-weight patients undergoing laparoscopic cholecystectomy. All patients were administered a single intravenous bolus of lidocaine (2%, 1.5 mg/kg) before the operation. Arterial blood samples were collected during the surgery to analyze the pharmacokinetics of lidocaine and its metabolites. The lidocaine-related adverse events (AEs) were recorded throughout the study. Results: The obese patients showed a significantly higher peak time (P = 0.008), half-life (P <0.0001), and volume of distribution (P <0.0001) of lidocaine compared to the normal-weight patients. Conversely, the lidocaine peak concentration (P = 0.035), clearance (P = 0.032), and elimination rate (P <0.0001) were lower in the patients with obesity. The differences in the pharmacokinetics of lidocaine metabolites between the two groups were similar to those of lidocaine. No serious AEs related to lidocaine were reported. Conclusion Obesity significantly affects the pharmacokinetics of lidocaine and its active metabolites, and administrating lidocaine intravenously based on adjusted body weight is safe and reasonable for obese patients. Trial registration ChiCTR2200064980, 25 October 2022

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Efficacy of intraoperative intravenous lidocaine for postoperative analgesia following bariatric surgery: a meta-analysis of randomized controlled studies

Cited by 11 publications

References 59 publications

Non-Opioid Analgesics and Adjuvants after Surgery in Adults with Obesity: Systematic Review with Network Meta-Analysis of Randomized Controlled Trials

Non-Opioid Analgesics and Adjuvants after Surgery in Adults with Obesity: Systematic Review with Network Meta-Analysis of Randomized Controlled Trials

Endometriosis: Where are we today? An Anesthesiologist’s Point of View

Pharmacokinetics of lidocaine and its active metabolites in patients with obesity undergoing laparoscopic bariatric surgery: A prospective clinical study

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