DataSheet_1_Perioperative intravenous lidocaine for postoperative pain in patients undergoing breast surgery: a meta-analysis with trial sequential analysis of randomized controlled trials.pdf

BackgroundThe effectiveness of intravenous lidocaine infusion in managing acute and chronic pain following breast surgery has been a topic of debate. This meta-analysis aims to assess the impact of perioperative intravenous lidocaine on the relief of postoperative pain among patients undergoing breast surgery.
MethodsA systematic search of databases was conducted to identify randomized controlled trials (RCTs) that compared the effects of intravenous lidocaine infusion with placebo or routine care in patients undergoing breast surgery. The primary outcome of interest was the occurrence of chronic post-surgical pain (CPSP) at the longest follow-up. Meta-analyses, incorporating trial sequential analysis, were performed using a random-effects model to assess the overall effect.
ResultsA total of twelve trials, involving 879 patients, were included in the analysis. Perioperative intravenous lidocaine demonstrated a significant reduction in the incidence of CPSP at the longest follow-up (risk ratio [RR] 0.62, 95% confidence interval [CI] 0.48-0.81; P = 0.0005; I2 = 6%). Trial sequential analysis (TSA) indicated that the cumulative z curve crossed the trial sequential monitoring boundary for benefit, providing sufficient and conclusive evidence. Furthermore, intravenous lidocaine was associated with decreased opioid consumption and a shorter length of hospital stay.
ConclusionPerioperative intravenous lidocaine is effective in relieving acute and CPSP in patients undergoing breast surgery.
Systematic review registrationhttps://inplasy.com/, identifier INPLASY2022100033.

背景：静脉输注利多卡因（intravenous lidocaine infusion）用于缓解乳腺手术后急性与慢性疼痛的疗效一直存在争议。本项荟萃分析旨在评估围术期静脉输注利多卡因对乳腺手术患者术后疼痛缓解的影响。
方法：本研究系统性检索各类数据库，以识别对比静脉输注利多卡因与安慰剂或常规护理对乳腺手术患者疗效的随机对照试验（randomized controlled trials, RCTs）。本研究的主要关注结局指标为最长随访周期内术后慢性疼痛（chronic post-surgical pain, CPSP）的发生情况。采用随机效应模型（random-effects model）结合试验序贯分析（trial sequential analysis, TSA）开展荟萃分析，以评估整体效应。
结果：本研究共纳入12项试验，涉及879例患者。围术期静脉输注利多卡因可显著降低最长随访周期内术后慢性疼痛的发生率（风险比[RR] 0.62，95%置信区间[CI] 0.48~0.81；P=0.0005；I²=6%）。试验序贯分析（TSA）结果显示，累积Z曲线跨越了获益的试验序贯监测界值，提供了充分且确凿的证据。此外，静脉输注利多卡因还可减少阿片类药物消耗量，并缩短住院时长。
结论：围术期静脉输注利多卡因可有效缓解乳腺手术患者的急性疼痛与术后慢性疼痛。
系统评价注册：https://inplasy.com/，标识符为INPLASY2022100033。