The impact of peri-operative intravenous lidocaine on postoperative outcome after elective colorectal surgery

Abstract

BACKGROUND There has recently been increasing interest in the use of peri-operative intravenous lidocaine (IVL) due to its analgesic, anti-inflammatory and opioid-sparing effects. However, these potential benefits are not well established in elective colorectal surgery. OBJECTIVES To examine the effect of peri-operative IVL infusion on postoperative outcome in patients undergoing elective colorectal surgery. DESIGN A meta-analysis of randomised controlled trials (RCTs) comparing peri-operative IVL with placebo infusion in elective colorectal surgery. The primary outcome measure was postoperative pain scores up to 48 h. The secondary outcome measures included time to return of gastrointestinal function, postoperative morphine requirement, anastomotic leak, local anaesthetic toxicity and hospital length of stay. DATA SOURCES PubMed, Scopus and the Cochrane Library databases were searched on 5 November 2018. ELIGIBILITY CRITERIA Studies were included if they were RCTs evaluating the role of peri-operative IVL vs. placebo in adult patients undergoing elective colorectal surgery. Exclusion criteria were paediatric patients, noncolorectal or emergency procedures, non-RCT methodology or lack of relevant outcome measures. RESULTS A total of 10 studies were included (n = 508 patients; 265 who had undergone IVL infusion, 243 who had undergone placebo infusion). IVL infusion was associated with a significant reduction in time to defecation (mean difference −12.06 h, 95% CI −17.83 to −6.29, I 2 = 93%, P = 0.0001), hospital length of stay (mean difference −0.76 days, 95% CI −1.32 to −0.19, I 2 = 45%, P = 0.009) and postoperative pain scores at early time points, although this difference does not meet the threshold for a clinically relevant difference. There was no difference in time to pass flatus (mean difference −5.33 h, 95% CI −11.53 to 0.88, I 2 = 90%, P = 0.09), nor in rates of surgical site infection or anastomotic leakage. CONCLUSION This meta-analysis provides some support for the administration of peri-operative IVL infusion in elective colorectal surgery. However, further evidence is necessary to fully elucidate its potential benefits in light of the high levels of study heterogeneity and mixed quality of methodology.

Regional techniques for pain management following laparoscopic elective colonic resection: A systematic review

“…A Cochrane review including 45 trials proved that lidocaine infusion reduced postoperative pain during the first 24 h postoperatively [ 66 ]. For colorectal surgery, a recent meta-analysis including 10 RCTs (508 patients) showed that lidocaine infusion significantly reduced postoperative pain scores, hospital length of stay and time of excretion [ 10 ]. However, it was based on high-level heterogeneity studies and included open and laparoscopic colonic and rectal surgery.…”

“…Thoracic epidural analgesia (TEA) has been proposed as the gold standard in open colorectal surgery; however, its benefits and efficacy have not been demonstrated yet in a patient undergoing laparoscopic colorectal surgery and may even increase LOS [ 8 ]. Therefore, alternative co-analgesic techniques have been proposed, such as abdominal wall block (9], intravenous lidocaine infusion [ 10 ] or wound infusion of local anaesthetics [ 11 ]; however, there is no international consensus about the optimal analgesic regimens.…”

Effect of perioperative intravenous lidocaine on postoperative outcomes in patients undergoing resection of colorectal cancer: a protocol for systematic review and meta-analysis

“…Specific to the field of colorectal surgery, a recently published meta-analysis within colorectal surgery provides support for the administration of perioperative IVL in terms of earlier return of gastrointestinal function, lower postoperative pain scores and reduced hospital LOS, 25 with no difference in complication rates or apparent issues surrounding local anaesthetic toxicity. Another systematic review examined the role of IVL in the setting of elective colorectal surgery and concluded that IVL provided limited benefit in the reduction of early postoperative pain and morphine requirement when compared with placebo.…”

Влияние Методов Послеоперационного Обезболивания На Моторную Функцию Желудочно-Кишечного Тракта У Детей С Перитонитом, Осложненным Интраабдоминальной Гипертензией

“…Використання внутрішньовенної інфузії лідокаїну в дорослих після абдомінальних хірургічних втручань супроводжувалось швидшим відновленням перистальтики й зменшенням часу до перших випорожнень [17][18][19]. Згідно з даними Alaa El-Deeb і співавт., внутрішньовенна інфузія лідокаїну в дітей після абдомінальних хірургічних втручань порівняно із системною аналгезією опіоїдами також супроводжувалась швидшим відновленням перистальтики кишечника [20].…”