Cochrane · systematic review · CD009642

Continuous intravenous perioperative lidocaine infusion for postoperative pain and recovery in adults

Weibel, S, Jelting, Y, Pace, NL, et al. · Cochrane Database of Systematic Reviews · 2018 · Cochrane Library

Anaesthesia2 versionsAMSTAR 2: not assessed

SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.

Questions

current version

GRADE rated

No studies

Included studies

No studies 0 · 0%Ungraded 2 · 20%Very low 8 · 80%Low 0 · 0%Moderate 0 · 0%High 0 · 0%

Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.

Questions and results

Current version only

Intravenous (IV) lidocaine compared to placebo or no treatment in patients undergoing any elective or urgent surgical procedure under general anaesthesia

Population: adult patients undergoing any elective or urgent surgical procedure under general anaesthesia

CD009642.PUB3 (current) · 5 questions

Outcome	Effect	Evidence	Status / GRADE
Pain (VAS 0 to 10 cm, 0 to 100 mm, NRS 0 to 10) Intravenous (IV) lidocaine vs placebo or no treatment	no estimate extracted	29 studies · 1656 participants	Very low Downgraded: risk of bias
Gastrointestinal recovery Intravenous (IV) lidocaine vs placebo or no treatment	RR 0.37 [0.15, 0.87]	4 studies · 273 participants	Very low Downgraded: risk of bias
Adverse events (e.g. the number of participants that died, or had arrhythmias, other heart rate disorders, or showed any signs of lidocaine toxicity) Intravenous (IV) lidocaine vs placebo or no treatment	no estimate extracted	NR	Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias
Postoperative nausea, 'overall' (0 to 24 h, to 48 h, to 72 h) Intravenous (IV) lidocaine vs placebo or no treatment	RR 0.78 [0.67, 0.91]	35 studies · 1903 participants	Very low Downgraded: risk of bias
Postoperative opioid consumption, 'overall' (MEQ, mg) Intravenous (IV) lidocaine vs placebo or no treatment	no estimate extracted	40 studies · 2201 participants	Very low Downgraded: risk of bias

Intravenous (IV) lidocaine compared to thoracic epidural analgesia (TEA) in patients undergoing any elective or urgent surgical procedure under general anaesthesia

Population: adult patients undergoing any elective or urgent surgical procedure under general anaesthesia

CD009642.PUB3 (current) · 5 questions

Outcome	Effect	Evidence	Status / GRADE
Pain (VAS 0 to 10 cm, 0 to 100 mm, NRS 0 to 10 Intravenous (IV) lidocaine vs thoracic epidural analgesia (TEA)	no estimate extracted	0 studies · 0 participants	Ungraded
Gastrointestinal recovery Intravenous (IV) lidocaine vs thoracic epidural analgesia (TEA)	no estimate extracted	1 study · 60 participants	Very low Downgraded: risk of bias, imprecision, inconsistency
Adverse events (e.g. the number of participants that died, or had arrhythmias, other heart rate disorders, or showed any signs of lidocaine toxicity) Intravenous (IV) lidocaine vs thoracic epidural analgesia (TEA)	no estimate extracted	NR	Very low Downgraded: risk of bias, imprecision, inconsistency
Postoperative nausea, 'overall' (0 to 24 h, to 48 h, to 72 h) Intravenous (IV) lidocaine vs thoracic epidural analgesia (TEA)	no estimate extracted	1 study · 60 participants	Very low Downgraded: risk of bias, imprecision, inconsistency
Postoperative opioid consumption, 'overall' (MEQ, mg) Intravenous (IV) lidocaine vs thoracic epidural analgesia (TEA)	no estimate extracted	0 studies · 0 participants	Ungraded

Lidocaine IV compared to placebo or no treatment in patients undergoing any elective or urgent surgical procedure under general anaesthesia ‐ "pain"

Population: patients undergoing any elective or urgent surgical procedure under general anaesthesia

CD009642.PUB2 · 6 questions

Outcome	Effect	Evidence	Status / GRADE
Pain score "early time points" ‐ All surgical procedures (VAS 0 to 10 cm) Lidocaine IV vs placebo or no treatment	no estimate extracted	23 studies · 1286 participants	Low Downgraded: inconsistency
Pain score "early time points" ‐ Open abdominal surgery (VAS 0 to 10 cm) Lidocaine IV vs placebo or no treatment	no estimate extracted	6 studies · 332 participants	Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness
Pain score "early time points" ‐ Laparoscopic abdominal surgery (VAS 0 to 10 cm) Lidocaine IV vs placebo or no treatment	no estimate extracted	9 studies · 470 participants	Low Downgraded: inconsistency
Pain score "early time points" ‐ Other surgery (VAS 0 to 10 cm) Lidocaine IV vs placebo or no treatment	no estimate extracted	8 studies · 484 participants	Very low Downgraded: inconsistency
Pain score "intermediate time points" ‐ All surgical procedures (VAS 0 to 10 cm) Lidocaine IV vs placebo or no treatment	no estimate extracted	25 studies · 1393 participants	Low Downgraded: inconsistency
Pain score "late time points" ‐ All surgical procedures (VAS 0 to 10 cm) Lidocaine IV vs placebo or no treatment	no estimate extracted	19 studies · 1077 participants	Low Downgraded: inconsistency

Lidocaine IV compared to placebo or no treatment in patients undergoing any elective or urgent surgical procedure under general anaesthesia ‐ "gastrointestinal recovery"

Population: patients undergoing any elective or urgent surgical procedure under general anaesthesia

CD009642.PUB2 · 6 questions

Outcome	Effect	Evidence	Status / GRADE
Postoperative ileus (dichotomous) Lidocaine IV vs placebo or no treatment	RR 0.38 [0.15, 0.99]	3 studies · 205 participants	Low Downgraded: imprecision, inconsistency, indirectness, publication bias
Time to first defaecation (h) Lidocaine IV vs placebo or no treatment	no estimate extracted	4 studies · 214 participants	Low Downgraded: inconsistency
Time to first flatus (h) Lidocaine IV vs placebo or no treatment	no estimate extracted	11 studies · 566 participants	Low Downgraded: inconsistency
Time to bowel movements/sounds (h) Lidocaine IV vs placebo or no treatment	no estimate extracted	6 studies · 288 participants	Low Downgraded: imprecision, inconsistency, indirectness, publication bias
Postoperative nausea (PONV), early (PACU) Lidocaine IV vs placebo or no treatment	RR 0.72 [0.53, 0.99]	7 studies · 440 participants	Moderate Downgraded: imprecision, inconsistency, indirectness, publication bias
Postoperative nausea (PONV), late (0 to 24h, ‐ 48h, ‐ 72h) Lidocaine IV vs placebo or no treatment	RR 0.82 [0.7, 0.97]	21 studies · 1084 participants	Low Downgraded: imprecision, inconsistency, indirectness, publication bias

Lidocaine IV compared to TEA in patients undergoing any elective or urgent surgical procedure under general anaesthesia

Population: patients undergoing any elective or urgent surgical procedure under general anaesthesia

CD009642.PUB2 · 3 questions

Outcome	Effect	Evidence	Status / GRADE
Pain score "intermediate time points" (VAS 0 to 10 cm) Lidocaine IV vs TEA	no estimate extracted	2 studies · 102 participants	Very low Downgraded: inconsistency
Pain score "late time points" (VAS 0 to 10 cm) Lidocaine IV vs TEA	no estimate extracted	2 studies · 102 participants	Very low Downgraded: inconsistency
Time to bowel movements/sounds (h) Lidocaine IV vs TEA	no estimate extracted	2 studies · 102 participants	Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness