Lidocaine for postoperative pain after cardiac surgery
Topical Lidocaine can be used for postoperative pain management following cardiac surgery and may aid in recovery, finds a recent study in the Journal of Cardiothoracic Surgery.

Lidocaine is one of the most widely used local anesthetics with well-known pharmacological properties. The purpose of this systematic review is to investigate the effects of lidocaine on postoperative pain scores and recovery after cardiac surgery.

A comprehensive database search was conducted by a reference librarian for RCTs. Eligible study designs included randomized controlled trials of lidocaine for postoperative pain management in adults undergoing cardiac surgery. After removal of duplicates, 947 records were screened for eligibility and 3 RCTs met inclusion criteria. Lidocaine was administered intravenously, topically, and intrapleurally.

Key findings included

[1] 2% lidocaine placed topically on chest tube prior to intraoperative insertion was associated with significantly lower pain scores and lower cumulative doses of fentanyl, and

[2] 2% lidocaine administered intrapleurally was associated with significantly lower pain scores and significant improvements in pulmonary mechanics.

--Lidocaine infusions were not associated with significant changes in pain scores or measures of recovery.

--No significant associations were observed between lidocaine and overall mortality, hospital length of stay, or ICU length of stay. No data were reported for postoperative nausea and vomiting or arrhythmias.

Due to the favorable risk profile of topical lidocaine and the need for further advancements in the postoperative care of adults after cardiac surgery, topically administered lidocaine could be considered for incorporation into established postoperative recovery protocols.