Table_2_Intravenous Infusion of Lidocaine for Bowel Function Recovery After Major Colorectal Surgery: A Critical Appraisal Through Updated Meta-Analysis, Trial Sequential Analysis, Certainty of Evidence, and Meta-Regression.DOCX

BackgroundIntravenous infusion of lidocaine (IVF-Lido) during the perioperative period is an option to accelerate bowel function recovery after major colorectal surgery. However, previous meta-analyses have shown inconsistent conclusions. Recent randomized controlled trials (RCTs) have been reported after the publication of a previous meta-analysis.
AimWe conducted an updated and comprehensive meta-analysis to determine the effects of IVF-Lido on time to first flatus and defecation after major colorectal surgery.
MethodsWe performed a systematic review according to the Preferred Reporting Items for the Systematic Reviews and Meta-Analysis Protocols 2020 guideline. Only RCTs were included. The revised Cochrane risk-of-bias tool was chosen for appraisal. Meta-analysis with meta-regression and trial sequential analysis was carried out. The Doi plot was presented to evaluate publication bias. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology was executed to evaluate the certainty of evidence (CoE).
ResultsThirteen RCTs with 696 participants were enrolled. IVF-Lido significantly decreased the time to first flatus [mean difference (MD) = −6.03 h; 95% confidence interval (CI): (−8.80, −3.26)] and first defecation [MD = −10.49 h; 95% CI: (−15.58, −5.41)]. Trial sequential analysis yielded identical results and ampleness of required information sizes. No obviousness in publication bias was detected, and the CoE in GRADE was low in both outcomes. Meta-regression showed that a significantly shorter time to the first defecation was associated with studies with more improvement in pain control in comparison of two groups and better-improved analgesia in the control group.
ConclusionsWe discretionarily suggest the use of IVF-Lido on postoperative bowel function recovery following major colorectal surgery. Beyond the analgesic effects, IVF-Lido might have additional benefits when postoperative pain relief has already been achieved. Considering the high heterogeneity in this updated meta-analysis, more RCTs are needed.
Systematic Review Registrationhttps://inplasy.com/inplasy-2020-7-0023/, INPLASY [202070023].

背景
围手术期静脉输注利多卡因（Intravenous infusion of lidocaine, IVF-Lido）是加速结直肠大手术后肠道功能恢复的可选方案。然而，既往荟萃分析得出的结论并不一致。且在既往荟萃分析发表后，又有新的随机对照试验（randomized controlled trial, RCT）被报道。

目的
本研究开展了一项更新且全面的荟萃分析，旨在明确IVF-Lido对结直肠大手术后首次排气及首次排便时间的影响。

方法
本研究遵循《系统评价与荟萃分析方案首选报告条目2020》（Preferred Reporting Items for the Systematic Reviews and Meta-Analysis Protocols 2020）指南开展系统评价，仅纳入随机对照试验。采用修订版Cochrane偏倚风险工具进行质量评价。通过Meta回归与试验序贯分析开展荟萃分析，并绘制Doi图以评估发表偏倚。采用推荐分级、评估、制定与评价（Grading of Recommendations, Assessment, Development, and Evaluations, GRADE）方法对证据确定性（certainty of evidence, CoE）进行评价。

结果
共纳入13项随机对照试验，涉及696名受试者。IVF-Lido可显著缩短首次排气时间[均数差（mean difference, MD）= -6.03 h；95%置信区间（confidence interval, CI）：(-8.80, -3.26)]及首次排便时间[MD = -10.49 h；95% CI：(-15.58, -5.41)]。试验序贯分析得出了一致的结果，且所需信息样本量充足。未检测到明显的发表偏倚，两项结局指标的GRADE证据确定性均为低级别。Meta回归分析显示，与对照组相比，疼痛控制改善更显著的研究中，首次排便时间显著更短，且对照组的镇痛效果更优。

结论
本研究审慎推荐在结直肠大手术后应用IVF-Lido以促进术后肠道功能恢复。除镇痛作用外，若已实现术后疼痛缓解，IVF-Lido或可带来额外获益。鉴于本更新版荟萃分析存在较高异质性，仍需开展更多随机对照试验。

系统评价注册信息
https://inplasy.com/inplasy-2020-7-0023/，INPLASY [202070023]。