Jawwad Mohammad, Dar Dawar Nadeem Aslam, Khan Rana Faheem Ullah, Chaudhry Aizaz, Arkam Faraz, Rao Asad Gul, Mir Yusra, Mubashir Mohammad Maheer, Mir Aqsa, Imran Haider, Maqbool Umar, Pereira Pierina Clementine
Department of Internal Medicine, Dow University of Health Sciences, Karachi 74200, Pakistan.
Department of General Surgery, Services Institute of Medical Sciences, Lahore 54610, Pakistan.
Anesthesiol Res Pract. 2025 Feb 28;2025:9822744. doi: 10.1155/anrp/9822744. eCollection 2025.
Pain management is an integral part of recovery after major abdominal surgeries. Traditionally, epidural analgesia is used for postoperative pain management in major abdominal surgeries. However, intravenous lidocaine has recently been proven to be a good alternative. However, there is very limited evidence comparing their efficacy in 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. We searched PubMed and Cochrane Library from inception to May 2024 to identify studies that match our topic. We performed all statistical analyses using RevMan. The primary outcome was pain scores. The other outcomes were opioid requirements, postoperative nausea and vomiting, hospital stay duration, and time to pass flatus. Seven studies (six randomized clinical trials and one observational study; = 643) were included. Our results suggest that epidural bupivacaine significantly reduced pain scores during the first 24 h postoperatively as compared with the patients who received intravenous lidocaine (Std. mean difference: -0.23; 95% confidence interval [CI]: -0.40, -0.06; and =0.008). There was no difference at 48 h (Std. mean difference: -0.09; 95% CI: -0.27, 0.08; and =0.028) and 72 h intervals (Std. mean difference: -0.08; 95% CI: -0.25, 0.09; and =0.037). Our study shows that epidural analgesia, particularly epidural bupivacaine, provides superior pain relief as compared to intravenous lidocaine during the first 24 h postoperatively. However, there was heterogeneity among studies. Thus, in future, large standardized randomized controlled trials are required.
疼痛管理是腹部大手术后恢复过程中不可或缺的一部分。传统上，硬膜外镇痛用于腹部大手术的术后疼痛管理。然而，静脉注射利多卡因最近已被证明是一种很好的替代方法。然而，比较它们在腹部大手术中疗效的证据非常有限。本综述的目的是比较硬膜外镇痛与静脉注射利多卡因在腹部大手术后减轻疼痛和减少阿片类药物消耗方面的有效性。我们检索了从创刊到2024年5月的PubMed和Cochrane图书馆，以识别与我们主题相符的研究。我们使用RevMan进行了所有统计分析。主要结局是疼痛评分。其他结局包括阿片类药物需求量、术后恶心和呕吐、住院时间以及排气时间。纳入了7项研究（6项随机临床试验和1项观察性研究；n = 643）。我们的结果表明，与接受静脉注射利多卡因的患者相比，硬膜外布比卡因在术后24小时内显著降低了疼痛评分（标准化平均差：-0.23；95%置信区间[CI]：-0.40，-0.06；P = 0.008）。在48小时（标准化平均差：-0.09；95%CI：-0.27，0.08；P = 0.028）和72小时间隔时没有差异（标准化平均差：-0.08；95%CI：-0.25，0.09；P = 0.037）。我们的研究表明，与静脉注射利多卡因相比，硬膜外镇痛，尤其是硬膜外布比卡因，在术后24小时内提供了更好的疼痛缓解。然而，研究之间存在异质性。因此，未来需要进行大型标准化随机对照试验。
