Lidocaine for postoperative pain after cardiac surgery: a systematic review

Abstract

Objective Lidocaine is one of the most widely used local anesthetics with well-known pharmacological properties. The purpose of this systematic review is to investigate the effects of lidocaine on postoperative pain scores and recovery after cardiac surgery. Methods A comprehensive database search was conducted by a reference librarian for randomized clinical trials (RCT) from January 1, 1980 to September 1, 2019. Eligible study designs included randomized controlled trials of lidocaine for postoperative pain management in adults undergoing cardiac surgery. After removal of duplicates, 947 records were screened for eligibility and 3 RCTs met inclusion criteria. Results Sources of bias were identified in 2 of 3 RCTs. Lidocaine was administered intravenously, topically, and intrapleurally. Key findings included [1] 2% lidocaine placed topically on chest tube prior to intraoperative insertion was associated with significantly lower pain scores and lower cumulative doses of fentanyl; and [2] 2% lidocaine administered intrapleurally was associated with significantly lower pain scores and significant improvements in pulmonary mechanics. Lidocaine infusions were not associated with significant changes in pain scores or measures of recovery. No significant associations were observed between lidocaine and overall mortality, hospital length of stay or ICU length of stay. No data were reported for postoperative nausea and vomiting or arrhythmias. Conclusions Due to the favorable risk profile of topical lidocaine and the need for further advancements in the postoperative care of adults after cardiac surgery, topically administered lidocaine could be considered for incorporation into established postoperative recovery protocols.

The impact of a postoperative multimodal analgesia pathway on opioid use and outcomes after cardiothoracic surgery

“…Some studies describe positive effects on analgesia, whereas others show no impact. Applying topical lidocaine patches at both chest tube and sternotomy sites resulted in significantly lower amounts of fentanyl delivered via patient-controlled analgesia (PCA) [28]. However, in a study of 39 patients after robotic cardiac valve surgery, 5% lidocaine transdermal patches with PCA were ineffective at reducing acute or persistent pain [29].…”

Effects of pecto-intercostal fascial block combined with rectus sheath block for postoperative pain management after cardiac surgery: a randomized controlled trial

“…[13] Intrapleural injection of lidocaine can also reduce drainage pain and improve pulmonary function after CABG, [14] even topically administered lidocaine could be useful. [6,15] The safety of these methods is uncertain as the probability of arrhythmia or wound infection caused by local anesthetics. RSB is widely used in laparoscopic surgery and targets the upper abdominal postoperative analgesia.…”

Effects of pecto-intercostal fascial block combined with rectus sheath block for postoperative pain management after cardiac surgery: a randomized controlled trial

“…Injection of bupivacaine into the pleural and mediastinal drains has been concluded to relieve pain after cardiac surgery [ 22 ]. Intrapleural injection of lidocaine can also reduce drainage pain and improve pulmonary function after CABG [ 23 ], and even topically administered lidocaine could be useful [ 6 , 24 ]. The safety of these methods is uncertain due to the probability of arrhythmia or wound infection caused by local anesthetics.…”