Effectiveness of intravenous lidocaine in preventing postoperative nausea and vomiting in pediatric patients: A systematic review and meta-analysis

BackgroundIntravenous lidocaine in adults undergoing general anesthesia has been shown to reduce the incidence of postoperative nausea and vomiting (PONV). However, the anti-postoperative vomiting (POV) effect of lidocaine in pediatric patients remains unclear. We conducted a systematic review and meta-analysis with Trial Sequential Analysis to evaluate the effect of intravenous lidocaine on prevention of POV/PONV.MethodsSix databases including trial registration sites were searched. Randomized clinical trials evaluating the incidence of POV/PONV after intravenous lidocaine compared with control were included. The primary outcome was the incidence of POV within 24 hours after general anesthesia. The incidence of POV was combined as a risk ratio with 95% confidence interval using a random-effect model. We used the I2 to assess heterogeneity. We evaluated the quality of trials using the Cochrane methodology, and we assessed quality of evidence using the Grading of Recommendation Assessment, Development, and Evaluation approach. We also assessed adverse events.Results and discussionSix trials with 849 patients were included, of whom 433 received intravenous lidocaine. Three trials evaluated the incidence of POV, and 3 evaluated the incidence of PONV. The overall incidence of POV within 24 hours after anesthesia was 45.9% in the lidocaine group and 63.4% in the control group (risk ratio, 0.73; 95% confidence interval, 0.53–1.00; I2 = 32%; p = 0.05). The incidence of PONV within 24 hours after anesthesia was 3.73% in the lidocaine group and 4.87% in the control group (RR, 0.76; 95% CI, 0.36–1.59; I2 = 0%; p = 0.47). The quality of evidence was downgraded to “very low” due to the study designs, inconsistency, imprecision, and possible publication bias.ConclusionOur meta-analysis suggests that intravenous lidocaine infusion may reduce the incidence of POV, however, the evidence quality was “very low.” Further trials with a low risk of bias are necessary.背景 接受全身麻醉的成人患者静脉输注利多卡因，已被证实可降低术后恶心呕吐（PONV, Postoperative Nausea and Vomiting）的发生率。然而，利多卡因针对儿科患者的术后呕吐（POV, Postoperative Vomiting）预防效果仍未明确。本研究开展了一项系统综述与荟萃分析，并结合试验序贯分析（Trial Sequential Analysis），以评估静脉输注利多卡因预防术后呕吐/术后恶心呕吐的效果。 方法 检索了包括试验注册平台在内的共6个数据库。纳入对比静脉输注利多卡因与对照组、评估术后呕吐/术后恶心呕吐发生率的随机临床试验。本研究的主要结局指标为全身麻醉后24小时内术后呕吐的发生率。采用随机效应模型，将术后呕吐发生率以风险比（RR）与95%置信区间（CI）进行合并分析。通过I²值评估研究间异质性。采用Cochrane协作网方法学评价试验质量，并采用推荐分级、评估、制定与评价（GRADE）方法评估证据质量。同时对不良事件进行了评价。 结果与讨论 共纳入6项临床试验，涉及849例患者，其中433例接受静脉输注利多卡因。3项试验评估了术后呕吐发生率，剩余3项评估了术后恶心呕吐发生率。麻醉后24小时内，利多卡因组术后呕吐总体发生率为45.9%，对照组为63.4%（风险比=0.73；95%置信区间：0.53~1.00；I²=32%；P=0.05）。麻醉后24小时内术后恶心呕吐总体发生率：利多卡因组为3.73%，对照组为4.87%（RR=0.76；95%CI：0.36~1.59；I²=0%；P=0.47）。由于研究设计存在局限、研究间异质性、结果不精确以及潜在的发表偏倚，证据质量被降为“极低”。 结论 本荟萃分析提示，静脉输注利多卡因或可降低术后呕吐的发生率，但现有证据质量为“极低”。未来仍需开展偏倚风险较低的相关临床试验。