Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jun 23:13:1101582.
doi: 10.3389/fonc.2023.1101582. eCollection 2023.

Perioperative intravenous lidocaine for postoperative pain in patients undergoing breast surgery: a meta-analysis with trial sequential analysis of randomized controlled trials

Jia Li  1 , Jiao Huang  1 , Jiang-Tao Yang  2 , Jing-Chen Liu  1
Affiliations

Perioperative intravenous lidocaine for postoperative pain in patients undergoing breast surgery: a meta-analysis with trial sequential analysis of randomized controlled trials

Jia Li et al. Front Oncol. .

Abstract

Background: The effectiveness of intravenous lidocaine infusion in managing acute and chronic pain following breast surgery has been a topic of debate. This meta-analysis aims to assess the impact of perioperative intravenous lidocaine on the relief of postoperative pain among patients undergoing breast surgery.

Methods: A systematic search of databases was conducted to identify randomized controlled trials (RCTs) that compared the effects of intravenous lidocaine infusion with placebo or routine care in patients undergoing breast surgery. The primary outcome of interest was the occurrence of chronic post-surgical pain (CPSP) at the longest follow-up. Meta-analyses, incorporating trial sequential analysis, were performed using a random-effects model to assess the overall effect.

Results: A total of twelve trials, involving 879 patients, were included in the analysis. Perioperative intravenous lidocaine demonstrated a significant reduction in the incidence of CPSP at the longest follow-up (risk ratio [RR] 0.62, 95% confidence interval [CI] 0.48-0.81; P = 0.0005; I2 = 6%). Trial sequential analysis (TSA) indicated that the cumulative z curve crossed the trial sequential monitoring boundary for benefit, providing sufficient and conclusive evidence. Furthermore, intravenous lidocaine was associated with decreased opioid consumption and a shorter length of hospital stay.

Conclusion: Perioperative intravenous lidocaine is effective in relieving acute and CPSP in patients undergoing breast surgery.

Systematic review registration: https://inplasy.com/, identifier INPLASY2022100033.

Keywords: breast surgery; chronic post-surgical pain; lidocaine; meta-analysis; opioid.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagram summarizing literature screening process.
Figure 2
Figure 2
Risk of bias summary.
Figure 3
Figure 3
Forest plot for chronic post-surgical pain.
Figure 4
Figure 4
Trial sequential analysis for chronic post-surgical pain at the longest follow up (scaled trial distance). Trial sequential analysis of seven trials (black filled squares) illustrating that the cumulative Z curve crossed the conventional boundary and the trial sequential monitoring boundary for benefit, establishing sufficient and conclusive evidence. A diversity-adjusted required information size of 1724 patients were calculated using α = 0.05 (two-sided), β= 0.20 (power of 80%), an anticipated relative risk reduction of 20%, and an event proportion of 32.75% in the control group.
Figure 5
Figure 5
Forest plot for acute post-surgical pain at rest.
Figure 6
Figure 6
Forest plot for acute post-surgical pain at movement.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Poleshuck EL, Katz J, Andrus CH, Hogan LA, Jung BF, Kulick DI, et al. . Risk factors for chronic pain following breast cancer surgery: a prospective study. J Pain (2006) 7(9):626–34. doi: 10.1016/j.jpain.2006.02.007 - DOI - PMC - PubMed
    1. Fecho K, Miller NR, Merritt SA, Klauber-Demore N, Hultman CS, Blau WS. Acute and persistent postoperative pain after breast surgery. Pain Med (2009) 10(4):708–15. doi: 10.1111/j.1526-4637.2009.00611.x - DOI - PubMed
    1. Bruce J, Thornton AJ, Powell R, Johnston M, Wells M, Heys SD, et al. . Psychological, surgical, and sociodemographic predictors of pain outcomes after breast cancer surgery: a population-based cohort study. Pain (2014) 155(2):232–43. doi: 10.1016/j.pain.2013.09.028 - DOI - PubMed
    1. Hamood R, Hamood H, Merhasin I, Keinan-Boker L. Chronic pain and other symptoms among breast cancer survivors: prevalence, predictors, and effects on quality of life. Breast Cancer Res Treat (2018) 167(1):157–69. doi: 10.1007/s10549-017-4485-0 - DOI - PubMed
    1. Schneiderhan J, Clauw D, Schwenk TL. Primary care of patients with chronic pain. Jama (2017) 317(23):2367–8. doi: 10.1001/jama.2017.5787 - DOI - PubMed

Publication types