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Background <p>Effective pain management is an integral part of recovery after major abdominal surgeries. Traditionally, epidural analgesia is mostly used for postoperative pain management in major abdominal surgeries. However, intravenous lidocaine has recently emerged as a good alternative. But there is very limited evidence comparing their efficacy in postoperative pain management following major abdominal surgery. The aim of this review is to compare the effectiveness of epidural analgesia with intravenous lidocaine in reducing pain and opioid consumption following major abdominal surgery.</p> Methods <p>We searched PubMed and Cochrane Library from inception to 1st July 2024 to identify studies that compared the efficacy of IV lidocaine with epidural analgesia in major abdominal surgery. Revised Cochrane risk-of-bias tool for Randomized Trials and The Newcastle − Ottawa quality assessment scale were used to assess the risk of bias for the included studies. We performed all statistical analyses using RevMan (version 5.4). The primary outcome was pain scores. The other outcomes were opioid requirements, postoperative nausea and vomiting, hospital stay duration and time to pass flatus. Results were pooled using a random effects model.</p> Results <p>Seven studies (six randomized clinical trials and one observational study; <i>n</i> = 643) were included. Our results suggest that epidural bupivacaine significantly reduced pain scores during the first 24-hours postoperatively as compared to the patients who received intravenous lidocaine (Std. Mean Difference: -0.23; 95% CI: -0.40, -0.06; <i>P</i> = 0.008). There was no difference at 48-hour (Std. Mean Difference: -0.09; 95% CI: -0.27, 0.08; <i>P</i> = 0.28) and 72-hour intervals (Std. Mean Difference:-0.08; 95% CI: -0.25, 0.09; <i>P</i> = 0.37).</p> Conclusion <p>Our meta-analysis shows that epidural analgesia particularly epidural bupivacaine provided superior pain relief as compared to intravenous lidocaine at 2-hour, 12-hour and 24-hour intervals postooperatively. Similarly, epidural analgesia group required less amount of rescue morphine post-surgery as compared to the intravenous lidocaine. Also, epidural analgesia was associated with lesser time to pass flatus. Furthermore, there was no difference in hospital stay duration and incidence of postoperative nausea and vomiting between the two groups. However high heterogeneity was seen due to the limitations which include studies with smaller sample size, differences in study designs and anesthesia protocols across the studies included. Thus, future large-scale randomized controlled trials with standardized treatment protocols are required to minimize heterogeneity.</p>

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Efficacy of Epidural Analgesia Compared to Intravenous Lidocaine for Postoperative Pain in Major Abdominal Surgery: A Systematic Review and Meta-Analysis

  • 期刊论文

  • 发表日期：

    2025年4月25日

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  • Amar Lal,
  • Shuita Kumari,
  • Kajal Kumari,
  • FNU Raja,
  • Rahul Rai,
  • Kapeel Kumar,
  • Hanesh Kumar,
  • Kainat Naeem,
  • Monazza Riaz,
  • Raveena Devi,
  • Hira Riaz

摘要

Background

Effective pain management is an integral part of recovery after major abdominal surgeries. Traditionally, epidural analgesia is mostly used for postoperative pain management in major abdominal surgeries. However, intravenous lidocaine has recently emerged as a good alternative. But there is very limited evidence comparing their efficacy in postoperative pain management following major abdominal surgery. The aim of this review is to compare the effectiveness of epidural analgesia with intravenous lidocaine in reducing pain and opioid consumption following major abdominal surgery.

Methods

We searched PubMed and Cochrane Library from inception to 1st July 2024 to identify studies that compared the efficacy of IV lidocaine with epidural analgesia in major abdominal surgery. Revised Cochrane risk-of-bias tool for Randomized Trials and The Newcastle − Ottawa quality assessment scale were used to assess the risk of bias for the included studies. We performed all statistical analyses using RevMan (version 5.4). The primary outcome was pain scores. The other outcomes were opioid requirements, postoperative nausea and vomiting, hospital stay duration and time to pass flatus. Results were pooled using a random effects model.

Results

Seven studies (six randomized clinical trials and one observational study; n = 643) were included. Our results suggest that epidural bupivacaine significantly reduced pain scores during the first 24-hours postoperatively as compared to the patients who received intravenous lidocaine (Std. Mean Difference: -0.23; 95% CI: -0.40, -0.06; P = 0.008). There was no difference at 48-hour (Std. Mean Difference: -0.09; 95% CI: -0.27, 0.08; P = 0.28) and 72-hour intervals (Std. Mean Difference:-0.08; 95% CI: -0.25, 0.09; P = 0.37).

Conclusion

Our meta-analysis shows that epidural analgesia particularly epidural bupivacaine provided superior pain relief as compared to intravenous lidocaine at 2-hour, 12-hour and 24-hour intervals postooperatively. Similarly, epidural analgesia group required less amount of rescue morphine post-surgery as compared to the intravenous lidocaine. Also, epidural analgesia was associated with lesser time to pass flatus. Furthermore, there was no difference in hospital stay duration and incidence of postoperative nausea and vomiting between the two groups. However high heterogeneity was seen due to the limitations which include studies with smaller sample size, differences in study designs and anesthesia protocols across the studies included. Thus, future large-scale randomized controlled trials with standardized treatment protocols are required to minimize heterogeneity.