| Objective:To evaluate the postoperative pain–alleviating and opioid sparing effect of Lidocaine in patients undergoing both open and laparoscopic abdominal surgery.Methods:Pubmed,Cochrane Library,Web of science,LILAC,EBSCO HOST,CNKI and Proquest databases were searched for relevant articles.Randomized controlled trials that assessed the effects of IV lidocaine compared to controls;epidural lidocaine or intraperitoneal lidocaine were included in this study.All adults(18 years or older)undergoing elective abdominal surgery under general anesthesia were included.Abdominal surgery was defined as surgery to intra-abdominal organs excluding urological,gynecological,vascular and superficial abdominal surgery;such as herniorrhaphy,herniotomy,and etc.Primary outcomes were mean pain scores for the first postoperative day,mean Postoperative pain scores in early(1-4 hours),intermediate(10-15)and late(24-30 hours)postoperative phases,total postoperative IV opioid consumption,and total opioid consumption in the first 24 hours after surgery.Secondary outcomes were Postoperative Nausea and vomiting(Dichotomous),Postoperative Nausea(Dichotomous),Postoperative vomiting(Dichotomous),time to first flatus after surgery in hours,and time to first defecation/bowel movement after surgery in hours.Results:29 articles were selected for qualitative and quantitative analysis.A total of 1777patients were enrolled in all these trials.Of these,934(52.6%)were adult females while 843(47.4%)were adult males.The sample size ranged from 20 to 134.In the comparison between IV Lidocaine and Placebo,SMD for mean pain scores for the first postoperative day was-1.02(95%CI-2.12 to 0.09,I~2=89%).For Pain scores after surgery:Early phase(1-4 hours),SMD was-0.79(95%CI-1.15 to-0.42;I~2=76%).For Pain scores after surgery:Intermediate phase(10-15 hours),The SMD favored Lidocaine-0.87(95%CI-1.51 to-0.22;I2=83%).For Pain scores after surgery:Late phase(24-30 hours),the total SMD was-0.60(95%CI-0.97 to-0.23;I2=80%).For Postoperative nausea,the pooled risk ratio was 0.72(95%CI 0.56 to 0.92;I2=0%)and it favored Lidocaine.For Postoperative vomiting,the pooled risk ratio was 0.95(95%CI 0.65 to 1.40;I2=0%)and it favored Lidocaine.For Postoperative nausea and vomiting,the pooled risk ratio was 0.71(95%CI0.47 to 1.06;I2=49%).For time to first flatus(Hours),the pooled mean difference was-6.25(95%CI-9.42 to-3.08;I2=62%).For time to first bowel movement/defecation(hours),the pooled mean difference was-6.30(95%CI-8.55 to-4.05;I2=10%).For total postoperative IV opioid consumption(IV morphine equivalents-mg),the total pooled mean difference was-16.49(95%CI-30.14 to-2.84;I2=91%).For total opioid consumption in the first 24 hours after surgery(IV morphine equivalents-mg),the pooled mean difference was-9.85(95%CI-16.47 to-3.22;I2=96%).In the comparison between IV Lidocaine and Intraperitoneal Lidocaine,SMD for pain scores after surgery:Early phase(1-4 hours)was-0.21(95%CI-1.73 to 1.32;I~2=93%).For pain scores after surgery:Late phase(24-30 hours),the SMD was-0.73(95%CI-3.14 to 1.67;I~2=97%).In the comparison between IV Lidocaine and Epidural Lidocaine,the pooled SMD was 0.34(95%CI-0.10 to 0.77;I2=38%)for Pain scores after surgery:Late phase(24-30 hours).For time to first flatus(hours),the pooled SMD was 0.80(95%CI 0.19 to 1.42;I2=75%).Conclusions:Lidocaine was better than placebo in reducing postoperative pain in all assessed time phases after surgery.The effect was more pronounced in the laparoscopic abdominal surgery groups,after sensitivity analyses.Regarding postoperative opioid consumption,IV Lidocaine showed some benefit in surgeries lasting less than two hours.IV Lidocaine also improved postoperative nausea and gastrointestinal motility by improving time to first bowel movement.Compared to IV Lidocaine,Intraperitoneal Lidocaine showed no benefit while epidural Lidocaine showed probable benefit in reducing time to first flatus... |
PDF Full Text Request