Page 19 - CASA Bulletin of Anesthesiology 2022; 9(5)
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Vol. 9, No 5, 2022
time to first bowel movements (hrs) (MD -7.92, 95% CI -12.71 to -3.13) and time to first flatus
(MD -4.09, 95% CI -6.30 to -1.87). There was no significant effect for lidocaine to shorten the
time to first bowel sounds.
The meta-analysis did not find a statistically significant difference between lidocaine infusion
and length of hospital stay .
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Postoperative nausea was found to be reduced in the lidocaine group (RR 0.78, 95% CI 0.67 to
0.91), however, IV lidocaine did not have a meaningful effect over postoperative vomiting (RR
0.83, 95% CI 0.63 to 1.08).
Lastly, the meta-analysis examined intraoperative, postoperative, and overall opioid consumption
and found clinically significant reduction in opioid consumption perioperatively. Intraoperative
opioid consumption (MEQ, mg) was found to be less in the lidocaine group compared to control
(MD -2.14, 95% CI -3.87 to -0.40). Postoperative opioid consumption, PACU (MEQ, mg) was
found to be less in the lidocaine group as well compared to control (MD -3.10, 95% CI -3.87 to -
2.32), and the overall postoperative opioid consumption (MEQ, mg) was reduced as well (MD -
4.52, 95% CI -6.25 to -2.79) .
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Although aggregate 95% CI showed beneficial effect, the 95% PI crossed the line of identity and
demonstrated both beneficial as well as clinical non-relevance for intraoperative opioid
consumption and postoperative opioid consumption groups. However, the only definitive benefit
was observed in the postoperative opioid consumption, PACU group with a 95% PI below 0,
which means there is predicted reduction of postoperative opioid consumption in the PACU with
IV lidocaine use .
11
In conclusion, despite reports of IV lidocaine’s beneficial effects in the perioperative period and
its adoption into ERAS protocols, the heterogeneity of the studies in the aggregate data cast a
shadow of uncertainty over the true effect of IV lidocaine. We are uncertain whether IV
lidocaine benefits postoperative pain scores, improves gastrointestinal function, reduces
postoperative nausea and vomiting, or reduces intraoperative and overall opioid consumption.
Thus, more studies are needed before we can make a definitive recommendation.
Acknowledgement: The authors thank Jeffrey Huang, MD for his advice, review, and editing the
article.
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