Topical Lidocaine Gel Reduces Pain Scores and Opioid Use Consumption After Following Cardiac Surgery

According to results of a systematic review published in the Journal of Cardiothoracic Surgery, topical lidocaine could be considered for postoperative care after cardiac surgery.

Researchers from the Mayo Clinic searched publication databases through September 2019 for randomized placebo-controlled clinical trials of lidocaine in postoperative cardiac surgery care. A total of 3 randomized clinical trials comprising 185 patients were included.

All patients underwent median sternotomy for coronary artery bypass graft surgery. Lidocaine was administered via intravenous infusion (n=44), topical application (n=22), or intrapleural injection (n=20).

Patients were assessed for pain by a visual analogue scale or numeric rating scale at 4 hours to 7 days after surgery.

For the study of intravenous lidocaine, no significant differences in pain scores were observed between the treatment and placebo groups at hours 4, 8, 16, 24, 48, and 96 hours. This study had severe imprecision and there was some concern for bias.

The use of topical 2% lidocaine gel on chest tubes prior to placement during surgery was associated with significantly lower tube-related pain scores compared with placebo. At extubation and 7 days after surgery, fewer individuals in the treatment group indicated the chest tube area was the most painful site. The patients who received the lidocaine-treated chest tubes pushed their patient-controlled analgesia button to receive fentanyl fewer times than control group participants. This study had a low risk for bias, but the review authors indicated there was some imprecision in the evidence.

The study of 12 mL 2% lidocaine from intrapleural administration found reduced pain scores at 1 and 2 days after surgery among the treatment group. This study was at high risk for bias and included severe imprecision.

This review was limited in that only 3 studies of the 947 candidate trials of lidocaine met the inclusion criteria. This fact, however, highlighted the need for additional studies of lidocaine in the setting of cardiac surgery.

The review authors concluded there was some evidence that topical lidocaine may reduce pain scores and opioid consumption after cardiac surgery.

Reference

Boswell MR, Moman RN, Burtoft M, et al. Lidocaine for postoperative pain after cardiac surgery: a systematic review. J Cardiothorac Surg. 2021;16(1):157. doi:10.1186/s13019-021-01549-0