Topical lidocaine holds potential for pain management after cardiac surgery: Study
USA: Topical lidocaine could be used for postoperative pain management following cardiac surgery and may aid in recovery, finds a recent study in the Journal of Cardiothoracic Surgery.
Compared to other surgeries, cardiac surgery is associated with considerable pain and there is ongoing research aimed at optimizing postoperative pain management. Effective acute postoperative pain management is important as greater acute pain severity during the postoperative period may lead to the development of chronic postoperative pain.
Lidocaine is one of the most widely used local anesthetics with well-known pharmacological properties. W. Michael Hooten, Mayo Clinic, Rochester, MN, USA, and colleagues aimed to investigate the effects of lidocaine on postoperative pain scores and recovery after cardiac surgery in the systematic review.
For this purpose, the researchers conducted a comprehensive database search by a reference librarian for randomized clinical trials (RCT) from January 1, 1980 to September 1, 2019. It 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.
Sources of bias were identified in 2 of 3 RCTs. Lidocaine was administered intravenously, topically, and intrapleurally.
Key findings of the study include:
· 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% 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.
"Due 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," wrote the authors.
Reference:
The study titled, "Lidocaine for postoperative pain after cardiac surgery: a systematic review," is published in the Journal of Cardiothoracic Surgery.
DOI: https://cardiothoracicsurgery.biomedcentral.com/articles/10.1186/s13019-021-01549-0
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