• Nasir Hussain, Richard Brull, Lauren Weber, Alexandrea Garrett, Marissa Werner, Ryan S D'Souza, Tamara Sawyer, Tristan E Weaver, Manoj Iyer, Michael K Essandoh, and Faraj W Abdallah.
• Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, OH, USA.
• Br J Anaesth. 2024 Mar 1; 132 (3): 575587575-587.

BackgroundBreast cancer is the most common cancer among women and tumour resection carries a high prevalence of chronic persistent postsurgical pain (CPSP). Perioperative i.v. lidocaine infusion has been proposed as protective against CPSP; however, evidence of its benefits is conflicting. This review evaluates the effectiveness of perioperative lidocaine infusions for breast cancer surgery.MethodsRandomised trials comparing perioperative lidocaine infusions with parenteral analgesia in breast cancer surgery patients were sought. The two co-primary outcomes were the odds of CPSP at 3 and 6 months after operation. Secondary outcomes included rest pain at 1, 6, 12, and 24 h; analgesic consumption at 0-24 and 25-48 h; quality of recovery; opioid-related side-effects; and lidocaine infusion side-effects. Hartung-Knapp-Sidik-Jonkman (HKSJ) random effects modelling was used.ResultsThirteen trials (1039 patients; lidocaine: 518, control: 521) were included. Compared with control, perioperative lidocaine infusion did not decrease the odds of developing CPSP at 3 and 6 months. Lidocaine infusion improved postoperative pain at 1 h by a mean difference (95% confidence interval) of -0.65 cm (-0.73 to -0.57 cm) (P<0.0001); however, this difference was not clinically important (1.1 cm threshold). Similarly, lidocaine infusion reduced oral morphine consumption by 7.06 mg (-13.19 to -0.93) (P=0.029) over the first 24 h only; however, this difference was not clinically important (30 mg threshold). The groups were not different for any of the remaining outcomes.ConclusionsOur results provide moderate-quality evidence that perioperative lidocaine infusion does not reduce CPSP in patients undergoing breast cancer surgery. Routine use of lidocaine infusions for perioperative analgesia and CPSP prevention is not supported in this population.Systematic Review ProtocolPROSPERO CRD42023420888.Copyright © 2023 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

31 keywords...

hide…