Comparative Effectiveness of Epidural Analgesia and Intravenous Lidocaine for Postoperative Pain in Major Abdominal Surgery: A Systematic Review and Meta-Analysis

Abstract

Background: Pain management is an integral part of recovery after major abdominal surgeries. Traditionally, epidural analgesia is used for postoperative pain management in major abdominal surgeries. However, intravenous lidocaine has recently been proven to be a good alternative. However, there is very limited evidence comparing their efficacy in major abdominal surgery. The aim of this review is to compare the effectiveness of epidural analgesia with intravenous lidocaine in reducing pain and opioid consumption following major abdominal surgery. Methods: We searched PubMed and Cochrane Library from inception to May 2024 to identify studies that match our topic. We performed all statistical analyses using RevMan. The primary outcome was pain scores. The other outcomes were opioid requirements, postoperative nausea and vomiting, hospital stay duration, and time to pass flatus. Results: Seven studies (six randomized clinical trials and one observational study; n = 643) were included. Our results suggest that epidural bupivacaine significantly reduced pain scores during the first 24 h postoperatively as compared with the patients who received intravenous lidocaine (Std. mean difference: -0.23; 95% confidence interval [CI]: -0.40, -0.06; and p=0.008). There was no difference at 48 h (Std. mean difference: -0.09; 95% CI: -0.27, 0.08; and p=0.028) and 72 h intervals (Std. mean difference: -0.08; 95% CI: -0.25, 0.09; and p=0.037). Conclusion: Our study shows that epidural analgesia, particularly epidural bupivacaine, provides superior pain relief as compared to intravenous lidocaine during the first 24 h postoperatively. However, there was heterogeneity among studies. Thus, in future, large standardized randomized controlled trials are required.

Keywords: analgesia; lidocaine; morphine; pain management; postoperative pain.

Figure 1

PRISMA flow diagram.

Figure 2

Forest plots of mean pain scores. (a) At 2 h interval. (b) At 12 h interval. (c) At 24 h interval. (d) At 48 h interval. (e) At 72 h interval.

Figure 3

Forest plots of mean daily morphine consumption equivalent to IV mg of morphine. (a) At 24 h interval. (b) At 48 h interval. (c) At 72 h interval.

Figure 4

Forest plot of (a) 3 day incidence of postoperative nausea and vomiting, (b) mean time to pass first flatus in hours, and (c) mean hospital duration in days.