Intravenous lidocaine for acute postoperative pain management: an umbrella review

Abstract

ntroduction: 80% of patients report pain related symptoms in the postoperative period, and intravenous lidocaine offers a promising effect to reduce pain. However, the findings about pain relief, side effects, and severity are inconsistent. Methods: Following the PRISMA 2020 recommendations the systematic reviews and meta-analyses which investigated acute postoperative pain control through intravenous lidocaine administration were analyzed. Searches in the following databases: PubMed, Scopus, Web of Science, Medline Ultimate, Cochrane Library, were included. The study quality was assessed with AMSTAR-2 criteria, and narrative analysis was used to re-synthesize data. Results: The database search resulted in 561 studies, finally 19 were eligible. The quality ranged from high (n=1) to moderate(n=3) to low (n=2), and to critically low (n=14). The effect of IV lidocaine was assessed in various surgical types, but mainly in laparoscopic, breast, and spinal surgeries. Significant decrease in pain scores, lower opioid consumption, faster gastrointestinal recovery was reported in most of the studies. Only mild and transient side effects without major toxicity were observed. Conclusion: Despite well-established safety of IV lidocaine use, the study quality and heterogeneity limit the evidence. Hence, further high-quality research is required for broader clinical applicability.