Efficacy and Safety of Lidocaine Patch in the Management of Acute Postoperative Wound Pain: A Comprehensive Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Abstract

Objective: This study sought to quantify the pooled effects of lidocaine patch (LP) on postoperative pain and side effects through a comprehensive review and meta-analysis. Approach: The study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), AMSTAR, and the Cochrane Collaboration. Randomized controlled trials comparing LP with placebo were retrieved from five electronic databases. Primary outcome in the study was cumulative intravenous morphine equivalent consumption (mg) within 24 h postoperatively. Results: Twelve trials comprising 617 patients were included in the final analysis. Primary result indicated that the analgesic effects LP were only statistical but not clinically significant of postoperative intravenous morphine consumption within 24 h (mean difference, -4.61 mg; 95% confidence interval, -8.09 to -1.14). Interestingly, the results of subgroup and meta-regression analysis indicated that preoperative administration of LP had potential advantages in postoperative wound pain management. It is also worthwhile to mention that LP provided a clinically important benefit in rest pain scores within 24-h postoperatively. Apart from these, other secondary outcome analysis did not uncover any particularly significant analgesic or safety advantages to LP. Finally, LP also does not increase the risk of any local anesthetic-related side effects. Innovation: This systematic review and meta-analysis provides moderate-to-high quality evidence undermining the role of LP for management of acute postoperative wound pain after surgical procedures and the justification for the associated extra costs. Conclusion: Taken together, the current evidence does not support LP as part of a routine multimodal analgesia strategy to alleviate early postoperative acute pain. However, further studies should explore the clinical value of preoperative administration and the long-term effect of LP.