Lidocaine patches after cesarean delivery: a meta-analysis of randomized controlled trials

Abstract

Objective: To investigate the impact of lidocaine patches use after cesarean delivery on postoperative pain and document adverse reactions STUDY ELIGIBILITY CRITERIA: Meta-analysis of randomized controlled trials (RCTs). We included all RCTs comparing lidocaine patch use after cesarean delivery with placebo. The primary outcome was pain at 24 hours postoperative measured through Visual Analogue Scale (VAS). Secondary outcomes were: pain at 12, 36, 48 hours and 72 hours measured through VAS scale; opioid consumption; and adverse reactions. The summary measures were reported as relative risk (RR) or as mean difference (MD) with 95% of confidence interval (CI).

Results: Three RCTs, including 219 pregnancies, were analyzed. The quality of the RCTs included was moderate. Overall, there was some clinical heterogeneity among RCTs. Lidocaine patches, compared to the placebo patches, were associated with a significant reduction in VAS pain score at 12 hours (1.58 vs 2.24, P value=.0006), 24 hours (1.8 vs 2.4, P value< .0001) and 36 hours (0.48 vs 1.68 P value<.00001), respectively. Lidocaine patches, compared with placebo, was associated with similar VAS scores at 48 and 72 hours, as well as similar opioid consumption and adverse reactions.

Conclusion: The use of lidocaine patches after cesarean delivery is associated with a significant decrease in pain scores at 12, 24 and 36 hours, as well as similar pain scores at 48 and 72 hours, opioid consumption, and adverse reactions. Based on these data, the use of lidocaine patches may be considered as part of a multimodal analgesia strategy after cesarean delivery.

Keywords: cesarean delivery; cesarean section; lidocaine; lidocaine patches; pain; patches; postoperative.