Introduction Various strategies have been proposed for postoperative pain control. Among those, intravenous lidocaine infusion (IVLI) has gained in interest. However, its clinical benefit remains unclear. This systematic review is an evaluation of the analgesic efficacy and safety of IVLI during general anesthesia. Methods A systematic search was performed using MED-LINE, EMBASE, Cochrane, and SCOPUS databases, likewise, grey literature. The review included all randomized controlled trials that used a placebo or any comparator and evaluated IVLI during general anesthesia for any type of surgery. Primary outcomes were pain control and opioid requirement. Secondary outcomes were mortality, length of stay, ileus recovery time, nausea/vomiting, and adverse events. Random effects models were used and heterogeneity was assessed using the I 2 index. to -5.56), time to first flatus (WMD -7.62 hr, 95% CI -10.78 to -4.45), time to first feces (WMD -10.71 hr, 95% CI -16.14 to -5.28), nausea/vomiting (risk ratios = 0.71, 95% CI 0.57-0.90), and hospital length of stay (WMD -0.17 days, 95% CI -0.41 to 0.07). Abdominal surgery was strongly associated with benefit. For the 12 studies that systematically screened adverse events, the
Results
123Can J Anesth/J Can Anesth (2011) 58:22-37 DOI 10.1007/s12630-010-9407-0 incidence of cardiac and neurologic adverse events was comparable. Eight studies observed toxic plasma levels. Discussion Perioperative IVLI reduced postoperative pain and opioid requirement, as well as ileus recovery time, hospital length of stay, and nausea/vomiting. Intravenous lidocaine infusion was effective mainly in abdominal surgery populations. Considering that toxic levels were detected and that adverse events were not systematically screened for in most studies, dose and safety of IVLI should be established before recommending its use.
RésuméIntroduction Plusieurs strate´gies ont e´te´propose´es pour le contrôle de la douleur postope´ratoire. Parmi ces strate´gies, la lidocaı¨ne par voie intraveineuse suscite un inte´reˆt croissant. Toutefois, ses avantages cliniques demeurent peu clairs. Cette revue me´thodique est une e´valuation de l'efficaciteá nalge´sique et de l'innocuite´de la lidocaı¨ne par voie intraveineuse pendant l'anesthe´sie ge´ne´rale. Méthode Une recherche me´thodique a e´te´re´alise´e dans les bases de donne´es MEDLINE, EMBASE, Cochrane et SCOPUS ainsi que dans la litte´rature grise. Cette revue a tenu compte de toutes les e´tudes randomise´es contrôle´es ayant utilise´un placebo ou un traitement de re´fe´rence et e´value´la lidocaı¨ne par voie intraveineuse pendant l'anesthe´sie ge´ne´rale, quel que soit le type de chirurgie. Les principaux crite`res d'e´valuation e´taient le contrôle de la douleur et le besoin en opioı¨des. Les crite`res d'e´valuation secondaires e´taient la mortalite´, la dure´e d'hospitalisation, le temps de re´cupe´ration du transit intestinal, les nause´es et vomissements et les e´ve´nements inde´sirables. Des mode`les a`effets ale´atoires ont e´teú tilise´s e...