Introduction
Materials and methods
Literature search
Inclusion criteria
Exclusion criteria
Intervention and comparator
Data extraction
Primary outcome
Secondary outcomes
Return of GI function
-
Time to first passage of flatus (hours).
-
Time to toleration of diet (hours).
-
Incidence of postoperative ileus.
-
Incidence of nausea and vomiting.
Pain
-
Numerical pain score at rest at 24 h (score 0–10, 0 = no pain, 10 worst imaginable pain, alternative methods converted to 0–10 range).
-
Numerical pain score on movement at 24 h (0–10 as above).
-
Opioid consumption over first 24 h after surgery (milligrams and morphine equivalent doses).
-
Total opioid consumption (milligrams).
Other
-
Length of stay (hours).
Subgroup analyses
Bias and quality assessment
Author | Number of participants | Operation | Intervention | Protocol | Additional analgesia | Modified quality score |
---|---|---|---|---|---|---|
IV Lidocaine versus placebo as part of a multimodal analgesic regimen | ||||||
Laparoscopic | ||||||
Elhafz [18] | 18 | Hemicolectomy n = 9 Total colectomy n = 4 Proctocolectomy n = 3 Sigmoid resection n = 1 | IV lidocaine n = 9 | IV lidocaine infusion 2 mg/minute if > 70 kg, or 1 mg/minute if < 70 kg, stopped on return of bowel function or day 5 postoperatively | Recovery—fentanyl 15–30 micrograms every 15 min, or morphine 2 mg every 20 min PRN | 7 |
Placebo n = 9 | IV saline infusion throughout, stopped on return of bowel function or day 5 postoperatively | PCA morphine 2 mg, lockout time 10 min | ||||
Kaba [19] | 40 | Right hemicolectomy n = 9 Left hemicolectomy n = 31 | IV lidocaine n = 20 | Lidocaine 1.5 mg/kg i.v. bolus at induction THEN by 2 mg/kg/h i.v. infusion THEN 1.33 mg/kg/h i.v. infusion postoperatively for 24 h | Paracetamol 1 g 30 min prior to end of surgery THEN every 6 h for first 24 h Ketorolac 30 mg IV every 8 h for first 24 h Piritramide [opioid] as rescue medication—1 mg, lockout 5 min After 24 h Paracetamol 1 g oral every 6 h Diclofenac 75 mg BD Tramadol 100 mg PRN | 14 |
Placebo n = 20 | Normal saline i.v. bolus at induction THEN i.v. infusion of normal saline throughout procedure and postoperatively for 24 h | |||||
Kim [20] | 68 | Right hemicolectomy n = 14 Left hemicolectomy n = 4 Anterior resection n = 49 Subtotal colectomy n = 1 | IV lidocaine n = 32 | IV bolus of lidocaine 1 mg/kg was given THEN IV infusion of lidocaine 1 mg/kg/h AND ketorolac 90 mg for 24 h | NSAIDs after ketorolac infusion stopped | 14 |
Placebo n = 36 | 5 ml bolus of normal saline THEN 90 mg ketorolac in 240 ml saline for 24 h | |||||
Tikuisis [21] | 60 | Laparoscopic anterior resection n = 60 | IV lidocaine n = 30 | IV bolus of lidocaine 1.5 mg/kg was given [maximum 100 mg] THEN IV infusion of lidocaine 2 mg/kg/h during the entire surgical procedure THEN 1 mg/kg/h in the postoperative anaesthesia care unit and continued for the first 24 h after surgery | Fentanyl 24 h post op infusion 0.1 µg/kg/hr Ketorolac 30 mg PRN | 12 |
Placebo n = 30 | IV bolus of normal saline THEN continuous infusion of normal saline during surgery and for 24 h after the operation | |||||
Placebo n = 20 | Normal saline via IV infusion and epidural throughout procedure | |||||
Open | ||||||
Kuo [22] | 60 | ‘Elective surgery for colon cancer’, procedure not further detailed | IV lidocaine n = 20 | Lidocaine 2 mg/kg i.v. infusion over 10 min prior to induction THEN 3 mg/kg/hr i.v. infusion for duration of procedure | Intraoperative: fentanyl 1 µg/kg Patient-controlled epidural analgesia [PCEA] postop with morphine 0.1 mg/ml in ropivacaine 0.2%. 4 ml bolus 15 min lockout | 13 |
Placebo n = 20 | Normal saline via IV infusion and epidural throughout procedure | |||||
Herroeder [23] | 60 | Ileocaecal resection n = 2 Right hemicolectomy n = 10 Left hemicolectomy n = 5 Subtotal colectomy n = 1 Proctocolectomy n = 4 Sigmoid resection n = 20 Anterior resection n = 9 Other n = 9 | IV lidocaine n = 31 | Lidocaine 1.5 mg/kg i.v. bolus at induction THEN 2 mg/min i.v. infusion during procedure terminated 4 h after skin closure | IV piritramide 30 min prior to end of procedure PCA 2 mg piritramide PRN, lockout of 10 min 1 g metamizol or 1 g paracetamol 6-hourly | 15 |
Placebo n = 29 | Saline i.v. bolus at induction THEN i.v. infusion during procedure terminated 4 h after skin closure | |||||
Staikou [24] | 60 | Right hemicolectomy n = 12 Left hemicolectomy n = 8 Sigmoidectomy n = 29 Anterior resection n = 5 Abdominoperineal resection n = 6 | IV lidocaine n = 20 | Bolus of 1.5 mg/kg lidocaine IV THEN continuous IV infusion at 2 mg/kg/hr, stopped at end of procedure | At start of skin suturing 20 mg ropivacaine and 1 mg morphine administered epidurally to all patients Intraoperative Remifentanil PCA with ropivacaine 2 mg/ml and morphine 0.1 mg/ml—released 4 ml per delivery, lockout of 20 min Up to 4 g paracetamol + 16 mg lornoxicam per day | 14 |
Placebo n = 20 | Saline infusion IV and epidurally at volumes and rates as if containing lidocaine, stopped at end of procedure | |||||
Harvey [11] | 22 | ‘Elective bowel surgery’, procedure not further detailed | IV lidocaine n = 11 | IV infusion postoperatively only of lidocaine 1 mg/min for 24 h | Morphine PCA | 12 |
Placebo n = 11 | Saline infusion 10 ml/hr postoperatively for 24 h | |||||
Ho [25] | 58 | Stoma formation n = 28 Anterior resection n = 24 Right hemicolectomy n = 14 Left hemicolectomy n = 2 Total colectomy n = 5 Abdominoperineal resection n = 4 Proctocolectomy n = 4 Other n = 4 | IV lidocaine n = 28 | 1.5 mg/kg over 5 min (lidocaine 2.5%, 0.06 ml/kg) immediately postinduction, followed by 1 mg/kg/h (lidocaine 2.5%, 0.04 ml/kg/h) for 48 h | IV fentanyl PCA Other multimodal agents given at the discretion of the anaesthetist | 14 |
Placebo n = 29 | Equal volume, rate and duration of infusion of normal saline |