Comparative efficacy of perioperative lidocaine infusion versus thoracic epidural analgesia for pain management in abdominal surgery: systematic review and meta-analysis
Eficácia comparativa da infusão perioperatória de lidocaína versus analgesia peridural torácica para o controle da dor em cirurgias abdominais: revisão sistemática e meta-análise
Gustavo R.M. Wegner, Bruno F.M. Wegner, Ramon Huntermann, Manoela L. Pinto, Júlia A.P. Vieira, Amanda P. de Souza, Francisco J.L. Bezerra
Abstract
Background
Recent randomized clinical trials have compared the perioperative use of Intravenous (IV) lidocaine and Thoracic Epidural Analgesia (TEA) for postoperative analgesia in patients undergoing abdominal surgery.
Methods
A systematic search was conducted on Embase, Web of Science (all databases), Cochrane Library, and PubMed on March 25, 2024, adhering to the Cochrane Handbook and PRISMA guidelines.
Results
Out of 1261 screened studies, 6 were included. TEA provided superior pain relief on a 0 to 10 pain scale at rest compared to IV lidocaine at 2 (n = 335, MD = -0.72, 95% CI -0.19 to -1.25, p = 0.007423, I2 = 83%) and 24 hours postoperatively (n = 402; MD = -0.18, 95% CI -0.12 to -0.23; p < 0.000001, I2 = 18%). However, no statistically significant differences were observed on pain scores at rest at 48 and 72 hours. TEA provided superior pain relief on a 0 to 10 pain scale during coughing at 24 hours postoperatively (n = 360; MD = -0.36, 95% CI -0.19 to -0.52, p = 0.000019, I2 = 2%), but no statistically significant differences were observed in pain scores on coughing at 48 and 72 hours. There were no statistically significant differences in postoperative nausea and vomiting, time to first flatus, or length of hospital stay.
Conclusion
TEA provides more effective postoperative pain relief compared to IV lidocaine during the first postoperative day, as evidenced by analyses of pain both at rest and during coughing.
Keywords
Resumo
Introdução
Ensaios clínicos randomizados recentes compararam o uso perioperatório de lidocaína intravenosa (IV) e analgesia peridural torácica (TEA) para controle da dor pós-operatória em pacientes submetidos a cirurgias abdominais.
Métodos
Foi realizada uma busca sistemática nas bases Embase, Web of Science (todas as bases), Cochrane Library e PubMed em 25 de março de 2024, seguindo o Cochrane Handbook e as diretrizes PRISMA.
Resultados
Das 1261 publicações triadas, 6 foram incluídas. A TEA proporcionou alívio da dor superior na escala de dor de 0 a 10 em repouso, em comparação com a lidocaína IV, tanto nas 2 horas (n = 335; MD = -0,72; IC 95% -0,19 a -1,25; p = 0,007423; I² = 83%) quanto nas 24 horas pós-operatórias (n = 402; MD = -0,18; IC 95% -0,12 a -0,23; p < 0,000001; I² = 18%). No entanto, não foram observadas diferenças estatisticamente significativas nas pontuações de dor em repouso nas 48 e 72 horas. A TEA também foi superior no alívio da dor na escala de dor de 0 a 10 durante a tosse às 24 horas (n = 360; MD = -0,36; IC 95% -0,19 a -0,52; p = 0,000019; I² = 2%), mas não houve diferenças significativas nas 48 e 72 horas. Não foram observadas diferenças estatisticamente significativas quanto a náuseas e vômitos pós-operatórios, tempo até a primeira eliminação de flatos ou tempo de internação hospitalar.
Conclusão
A TEA proporciona alívio da dor pós-operatória mais eficaz do que a lidocaína IV durante o primeiro dia após a cirurgia, tanto em repouso quanto durante a tosse.
Palavras-chave
Referencias
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Submitted date:
11/10/2024
Accepted date:
28/02/2025
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