Lidocaine Patch for Postoperative Pain Can Be Used in Multimodal Analgesia

Lidocaine patches can help with postoperative pain and reduce the need for opioids when used in combination with other pain relief methods. However, they do not appear to significantly increase patient satisfaction with pain management. These are the findings of a study published in The Clinical Journal of Pain.

Researchers conducted a meta-analysis using information obtained from PubMed, Embase, and the Cochrane Central Register of Controlled Trials to evaluate whether a lidocaine patch is beneficial for postoperative pain as an option for multimodal analgesia. Two researchers conducted the study screening, risk bias assessment, and data extraction independently. The meta-analysis was conducted using Review Manager (version 5.4, Cochrane collaboration). The evaluation metrics included postoperative pain scores, opioid consumption, and patient satisfaction.

The researchers included a total of 16 randomized controlled trials with data from 918 patients, of which, 462 patients used lidocaine patches, and 456 patients did not use patches or used blank patches. All of the patients received standard postoperative analgesia, including drugs on time or patient-controlled analgesia. However, rescue analgesia was used for patients who reported pain scores above 4 or 5.

The researchers looked at:

• postoperative pain scores (measured on a scale from 0 to 10; 0 = no pain and 10 = most severe pain),
• opioid consumption (converted into parenteral morphine milligram equivalents), and
• patient satisfaction (compared number of patients satisfied with postoperative pain control or number of patients who thought the patch worked).

The lidocaine patch group had significantly lower pain scores compared with the other group at 12, 24, and 48 hours after the surgery. The difference in pain scores was:

• -1.32 (95% CI, -1.96 to -0.68), P <.0001; I2=92% at 12 hours,
• -1.23 (95% CI, -1.72 to -0.75), P <.00001; I2=92% at 24 hours, and
• -0.25 (95% CI, -0.29 to -0.21), P <.00001; I2=98% at 48 hours.

Additionally, the lidocaine patch group required less opioid medication with a difference of -3.57 (95% CI, -5.06 to -2.09), P <.00001; I2=96%.

Although the lidocaine patch group appeared to be more satisfied, there was no significant difference (risk ratio, [RR], 1.50 [95% CI, 0.74-3.05], P =.26) between the 2 groups.

Among several study limitations, the dosage and administration of lidocaine patches and the types of surgery were not consistent. The consumption of nonopioid analgesics was not analyzed.

The researchers concluded “using lidocaine patches in the perioperative period can reduce postoperative pain scores (at 12, 24, and 48 h after surgery) and reduce opioid consumption and seemed to have a higher patient satisfaction, but without a significant difference.”