Perioperative intravenous lidocaine infusion improves postoperative analgesia after hysterectomy: a systematic review and meta-analysis of randomized controlled trials

Abstract

Background: The effectiveness of intravenous lidocaine in reducing acute pain after hysterectomy remains uncertain. The authors conducted a meta-analysis of randomized controlled trials (RCTs) to investigate the impact of intravenous lidocaine on posthysterectomy recovery.

Methods: This study was completed based on the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. A systematic search was conducted in PubMed/MEDLINE, the Cochrane Controlled Trials Register (CENTRAL), and Embase up to 27 July 2023. The authors identified RCTs involving hysterectomy patients comparing lidocaine to a placebo. Outcome measures included postoperative pain scores at rest and during movement, opioid consumption, postoperative nausea and vomiting (PONV), improvements in functional gastrointestinal recovery, and Quality of Recovery scores.

Results: Nine RCTs were included in the meta-analysis, comprising 352 patients who received intravenous lidocaine and 354 controls. The analysis revealed that intravenous lidocaine significantly reduced postoperative pain scores at rest at 2, 6, 8, and 24 h following hysterectomy, as well as postoperative opioid consumption within 24 h and PONV rates. Furthermore, no observed benefit was noted in shortening the time to first flatus with intravenous lidocaine administration posthysterectomy.

Conclusion: Intravenous lidocaine administration effectively reduces acute postoperative pain, opioid consumption, and PONV rates following hysterectomy. Lidocaine serves as an opioid-sparing agent, reducing the morphine equivalent dose while maintaining a similar degree of postoperative pain.

Figure 1

Flowchart of systematic search. As per PRISMA guidelines.

Figure 2

The risk of bias of the included RCTs. (A) Risk of bias graph. Review authors’ judgments about each risk of bias item presented as percentage across all included studies. (B) Risk of bias summary. Review authors’ judgements about each single study, using red, yellow, and green to represent high, medium, and low risk, respectively.

Figure 3

Forest plot comparing lidocaine to control for postoperative pain scores at rest at 2(A), 4(B), 6(C), 8(D), 12(E), 24(F), and 48(G) hours.

Figure 4

Forest plot comparing lidocaine to control for postoperative morphine consumption within 24 h postoperative.

Figure 5

(A) Forest plot demonstrating lidocaine versus control in reducing postoperative vomiting and nausea. (B) Forest plot comparing lidocaine to control for functional gastrointestinal recovery.