Intraperitoneal lidocaine instillation during abdominal hysterectomy: a systematic review and meta-analysis of randomized placebo-controlled trials.

Abstract

AIM\nTo perform a systematic review and meta-analysis of all randomized placebo-controlled trials (RCTs) that inspected the analgesic benefits of intraperitoneal lidocaine instillation among patients undergoing abdominal hysterectomy.\n\n\nMETHODS\nFive electronic databases were inspected from till August 5, 2021. The eligible RCTs were evaluated for risk of bias. The pooled endpoints were summarized as mean difference (MD) or risk ratio (RR) with 95% confidence interval (CI).\n\n\nRESULTS\nFive RCTs met the inclusion criteria comprising 263 patients (119 and 117 patients were allocated to lidocaine and control group, respectively). The included RCTs demonstrated a low risk of bias. The postoperative pain score at rest was significantly lower in favor of the lidocaine group (MD=-1.01, 95% CI [-1.20, -0.81], p<0.001), and subgroup analysis demonstrated the same at 2, 4, 8, 12, 24, and 48 hours postoperatively. Moreover, the postoperative pain score at moving was significantly lower in favor of the lidocaine group (MD=-0.67, 95% CI [-1.01, -0.33], p<0.001), and subgroup analysis demonstrated the same at 2 and 48 hours postoperatively. The postoperative morphine consumption during 0-24 hours was significantly lower in favor of the lidocaine group (n=5 RCTs, MD=-7.29 mg, 95% CI [-13.22, -1.37], p=0.02). The rate of postoperative vomiting was significantly lower in favor of the lidocaine group (n=4 RCTs, RR=0.54, 95% Ci [0.31, 0.95], p=0.03).\n\n\nCONCLUSION\nAmong patients undergoing abdominal hysterectomy, intraperitoneal lidocaine instillation is feasible, cheap, safe, and associates with effective analgesia in terms of reduced postoperative pain score and morphine consumption.