The effect of systemic lidocaine on post-operative opioid consumption in ambulatory surgical patients: a meta-analysis of randomized controlled trials

Abstract

Background Ambulatory surgical procedures continue to grow in relevance to perioperative medicine. Clinical studies have examined the use of systemic lidocaine as a component of multimodal analgesia in various surgeries with mixed results. A quantitative review of the opioid-sparing effects of systemic lidocaine in ambulatory surgery has not been investigated. The primary objective of this study was to systematically review the effectiveness of systemic lidocaine on postoperative analgesic outcomes in patients undergoing ambulatory surgery. Methods We performed a quantitative systematic review of randomized controlled trials in electronic databases (Cochrane Library, Embase, PubMed, and Google Scholar) from their inception through February 2019. Included trials investigated the effects of intraoperative systemic lidocaine on postoperative analgesic outcomes, time to hospital discharge, and adverse events. Methodological quality was evaluated using Cochrane Collaboration’s tool and the level of evidence was assessed using GRADE criteria. Data was combined in a meta-analysis using random-effects models. Results Five trials evaluating 297 patients were included in the analysis. The pooled effect of systemic lidocaine on postoperative opioid consumption at post-anesthesia care unit revealed a significant effect, weighted mean difference (95% CI) of − 4.23 (− 7.3 to 1.2, P = 0.007), and, at 24 h, weighted mean difference (95% CI) of − 1.91 (− 3.80 to − 0.03, P = 0.04) mg intravenous morphine equivalents. Postoperative pain control during both time intervals, postoperative nausea and vomiting reported at post anesthesia care unit, and time to hospital discharge were not different between groups. The incidence rate of self-limiting adverse events of the included studies is 0.007 (2/297). Conclusion Our results suggest that intraoperative systemic lidocaine as treatment for postoperative pain has a moderate opioid-sparing effect in post anesthesia care unit with limited effect at 24 h after ambulatory surgery. Moreover, the opioid-sparing effect did not impact the analgesia or the presence of nausea and vomiting immediately or 24 h after surgery. Clinical trials with larger sample sizes are necessary to further confirm the short-term analgesic benefit of systemic lidocaine following ambulatory surgery. Trial registration PROSPERO (CRD42019142229)

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“…Recent literature J Gastrointestin Liver Dis, June 2023 Vol. 32 No 2: 156-161 linked intravenous lidocaine administration with more than just less opioid consumption, but even lower pain scores, less post-operative nausea and vomiting, reduced duration of ileus and a shorter hospital stay [28,33,34]. Our results confirmed the results of a number of studies focusing on early recovery after abdominal surgeries when patients received intravenous lidocaine [34][35][36][37].…”

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“…For comparing our results with prior literature, it can be noted that the use of IV lidocaine has been most commonly reported in a surgical setting ( 42 ). While the majority of studies on surgical patients indicate that lidocaine is an effective analgesic for postoperative pain control ( 10 , 11 ), few trials have indicated that systemic lidocaine may offer no beneficial effect in the postoperative period ( 43 , 44 ). However, it is important to note that majority of the studies assessing the efficacy of IV lidocaine in a surgical setting have compared the drug with placebo or used IV lidocaine as an adjunct to a baseline analgesic.…”

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