Efficacy of intraoperative intravenous lidocaine for postoperative analgesia following bariatric surgery: a meta-analysis of randomized controlled studies

Kuo-Chuan Hung; Ying-Jen Chang; I-Wen Chen; Yang-Pei Chang; Sheng-Fu Chiu; Cheuk-Kwan Sun

doi:10.1016/j.soard.2021.08.014

Efficacy of intraoperative intravenous lidocaine for postoperative analgesia following bariatric surgery: a meta-analysis of randomized controlled studies

Surg Obes Relat Dis. 2022 Jan;18(1):135-147. doi: 10.1016/j.soard.2021.08.014. Epub 2021 Sep 1.

Authors

Kuo-Chuan Hung¹, Ying-Jen Chang², I-Wen Chen³, Yang-Pei Chang⁴, Sheng-Fu Chiu⁵, Cheuk-Kwan Sun⁶

Affiliations

¹ Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan; General Education Center, Chia Nan University of Pharmacy and Science, Tainan City, Taiwan.
² Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan; Department of Recreation and Health-Care Management, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan city, Taiwan.
³ Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan.
⁴ Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁵ Department of Oral and Maxillofacial Surgery, Chi Mei Hospital, Liouying, Tainan City, Taiwan.
⁶ Department of Emergency Medicine, E-Da Hospital, Kaohsiung City, Taiwan; College of Medicine, I-Shou University, Kaohsiung City, Taiwan. Electronic address: researchgate000@gmail.com.

PMID: 34565683
DOI: 10.1016/j.soard.2021.08.014

Abstract

Background: The impact of intravenous lidocaine in adults undergoing laparoscopic bariatric surgeries (LBS) remains unclear.

Objectives: This study aimed at investigating the effect of intravenous lidocaine on postoperative opioid consumption and recovery following LBS.

Setting: Meta-analysis.

Methods: We searched databases including MEDLINE, Embase, Google Scholar, and the Cochrane Library for randomized controlled trials that evaluated the use of intravenous lidocaine compared to placebo only prior to May 2021. The primary outcome was 24-hour postoperative opioid consumption, while secondary outcomes included pain score, quality of recovery (QOR)-40 score, length of hospital stay (LOS), and postoperative nausea/vomiting (PONV).

Results: Seven trials (496 participants) were included. Intraoperative intravenous lidocaine significantly reduced 24-hour equivalent morphine consumption (mean difference [MD]: -11.97 mg; 95% confidence interval [CI]: -23.12 to -.83), pain score at 1 to 3 hours (MD: -.77; 95% CI: -1.5 to -.04), and LOS (MD: -8.93 hr; 95% CI: -13.41 to -4.44) without positive impact on 24-hour pain score and PONV. There was also an increase in time to first opioid requirement (MD: 20.23 min; 95% CI: 11.76-28.7) and QOR-40 score (MD: 24.38; 95% CI: 5.57-43.18). However, sensitivity analysis demonstrated evidence supporting the beneficial effect of lidocaine only for time to first opioid requirement and QOR-40. The associations of intraoperative intravenous lidocaine with reductions in morphine consumption, pain score at 1 to 3 hours, and LOS after LBS were also weak.

Conclusion: Intraoperative intravenous lidocaine during LBS prolonged time to first opioid requirement and improved quality of recovery postoperatively without 24-hour pain or nausea/vomiting benefits. Due to the small number of trials, larger studies are warranted to verify our findings.

Keywords: Laparoscopic bariatric surgery; Lidocaine; Opioid; Quality of recovery.

Publication types

Meta-Analysis
Review

MeSH terms

Adult
Analgesia*
Analgesics, Opioid / therapeutic use
Anesthetics, Local
Bariatric Surgery*
Humans
Lidocaine / therapeutic use
Pain, Postoperative / drug therapy
Pain, Postoperative / prevention & control
Randomized Controlled Trials as Topic

Substances

Analgesics, Opioid
Anesthetics, Local
Lidocaine