Peri-operative use of continuous intravenous lidocaine on postoperative pain: A narrative review

Abstract

Background: Pain is a common postoperative complication. Lidocaine is a registered drug in Belgium as a local anesthetic and is known to have analgetic and anti-inflammatory properties. Lidocaine has also shown to prevent hypersensitization and hyperanalgesia and it might even prevent the development of chronic pain.

Objective: Our objective is to evaluate the efficacy of the use of perioperative intravenous lidocaine on postoperative pain.

The primary outcome is to assess a reduced pain score in the early postoperative phase. The secondary outcome is to assess reduced opioid consumption.

Methods: The literature search took place between February first and March thirtieth 2023 and was based on PRISMA guidelines. We used both Elicit and Pubmed as research databases. In total seven out of 57 articles were included based on title, abstract and thorough reading.

Results: Four out of seven articles described a positive effect of a perioperative intravenous lidocaine infusion on postoperative pain scores during the first four hours after surgery. The patients who benefit most are those undergoing colorectal surgery. Results on reduction of opioid use were inconclusive.

Discussion: Most consensus could be found for postoperative pain relieve in the first four hours after surgery. The scale of inconsistency between study protocols provides only low quality of evidence. More homogenous study protocols might present more reliable comparisons and lead to higher quality evidence.

Conclusion: The overall consensus is that continuous intravenous lidocaine might reduce postoperative pain in the first four hours after surgery.