Intravenous lidocaine for postoperative analgesia management in paediatrics

Abstract

BACKGROUND The administration of intravenous lidocaine during the peri-operative period may improve pain management after paediatric surgery. OBJECTIVE To explore the decrease in postoperative pain intensity and opioid consumption associated with peri-operative lidocaine administration in the paediatric population. DESIGN A systematic review with meta-analysis of randomised controlled trials and a Grading of Recommendations Assessment, Development and Evaluation (GRADE) analysis. DATA SOURCES Extensive literature review. ELIGIBILITY CRITERIA This study includes clinical trials conducted during surgery that examined the effect of intravenous lidocaine compared with placebo on postoperative pain management. RESULTS Lidocaine administration decreased pain intensity in PACU (standardised mean difference (SMD) = -1.89 [-3.75, -0.03], I 2 = 97%, P of I 2 < 0.001) and on postoperative day 1 (SMD = -2.02 [-3.37, -0.66], I 2 = 96%, P of I 2 < 0.001, number of studies = 5). Lidocaine was associated with a decrease in opioid consumption on postoperative day 1 (SMD = -1.2 [-2.19, -0.2], I 2 = 93%, P of I 2 < 0.001) but not on postoperative day 2 (SMD = -1.73 [-3.9, 0.44], I 2 = 96%, P of I 2 < 0.001). GRADE analyses resulted in low-quality results. Subgroup analyses revealed that pain intensity in PACU and opioid consumption on postoperative day 1 decreased when lidocaine was administered during both the intra-operative and postoperative periods. CONCLUSIONS The use of lidocaine is associated with improved pain management. However, further studies are needed to increase the level of evidence and determine the optimal administration regimen for pain management.