Effect of Perioperative Intravenous Lidocaine Infusion on Acute and Chronic Pain after Breast Surgery: A Meta‐Analysis of Randomized Controlled Trials

• Published in: Pain practice Vol. 17; no. 3; pp. 336 - 343
• Main Authors: Chang, Yuan‐Ching, Liu, Chien‐Liang, Liu, Tsang‐Pai, Yang, Po‐Sheng, Chen, Ming‐Jen, Cheng, Shih‐Ping
• Format: Journal Article
• Language: English
• Published: United States 01.03.2017
• Subjects: acute pain; Acute Pain - diagnosis; Acute Pain - drug therapy; Analgesics - administration & dosage; breast surgery; chronic pain; Chronic Pain - diagnosis; Chronic Pain - drug therapy; Female; Humans; Infusions, Intravenous; intravenous infusion; lidocaine; Lidocaine - administration & dosage; Mastectomy - adverse effects; meta‐analysis; pain; Pain Measurement - drug effects; Pain Measurement - methods; Pain, Postoperative - diagnosis; Pain, Postoperative - drug therapy; Perioperative Care - methods; Randomized Controlled Trials as Topic - methods; Treatment Outcome; chronic pain; pain; acute pain; meta-analysis; breast surgery; intravenous infusion; lidocaine
• ISSN: 1530-7085; 1533-2500
• DOI: 10.1111/papr.12442

Objectives Intravenous lidocaine infusion has been shown to reduce postoperative pain among patients undergoing abdominal surgery. This study aimed to evaluate the effects of perioperative lidocaine administration in breast surgery. Methods A meta‐analysis of randomized controlled trials comparing lidocaine infusion vs. placebo/routine treatment was performed. Standardized mean difference (SMD) or risk ratio (RR) with 95% confidence intervals (CIs) was calculated from pooled data. Random‐effects models were used, and heterogeneity was assessed. Results A total of 4 reports (3 primary studies and 1 extension) with 84 patients randomized to the lidocaine group and 83 patients randomized to the control group were included. There was no difference in pain scores at rest or during activity between the 2 groups from postoperative 2 hours to 3 days. At postoperative 72 hours, the lidocaine group had fewer analgesics consumed (SMD, −0.479; 95% CI, −0.914 to −0.043; P = 0.031). Chronic pain was assessed 3 to 6 months after breast surgery in 51 patients of the lidocaine group and 46 patients of the control group. Patients in the lidocaine group had significantly lower risk for the development of chronic pain (RR, 0.332; 95% CI, 0.141 to 0.781; P = 0.012). Conclusion The results indicate no significant benefits of intravenous lidocaine infusion in terms of acute postoperative pain. Although lidocaine seems to attenuate the risk of chronic pain after breast surgery, there is insufficient evidence to conclude that lidocaine infusion is of proved benefit because the results were based on a limited number of small trials.