Abstract
ObjectiveLidocaine 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.MethodsA 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.ResultsSources 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.ConclusionsDue 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.
Highlights
Cardiac surgery, compared to other major surgical procedures, is associated with considerable pain [1], and research aimed at optimizing postoperative pain management is ongoing [2]
The key findings of this systematic review include (1) 2% lidocaine placed topically on chest tubes 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 forced expiratory volume at 1 sec (FEV1)
The results of this study suggest that the pharmacology of topical lidocaine warrants further consideration
Summary
Cardiac surgery, compared to other major surgical procedures, is associated with considerable pain [1], and research aimed at optimizing postoperative pain management is ongoing [2]. Pain after cardiac surgery is most severe on postoperative day (POD) 1 and 2 [3, 4]. In the Enhanced Recovery After Surgery Society recommendations for perioperative cardiac surgery care, multimodal opioid-sparing pain management plans are strongly recommended (Class I recommendation) [8]. Multimodal pain management after cardiac surgery frequently incorporates local anesthetics administered intravenously, infiltrated perineurally, or infused into the epidural space [9]. The effects of lidocaine on postoperative pain and recovery after cardiac surgery have not been systematically reviewed. The primary objective of this systematic review is to investigate the effects of lidocaine on postoperative pain scores after cardiac surgery. Adverse effects associated with lidocaine, including arrhythmias and allcause mortality, will be documented
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