Photo Credit: iStock.com/CasarsaGuru

Thoracic epidural analgesia provides pain relief superior to that of intravenous lidocaine in the first 24 hours after abdominal surgery, researchers reported.

Thoracic epidural analgesia (TEA) is superior to IV lidocaine for postoperative pain relief during the first 24 hours after abdominal surgery, but IV lidocaine provides comparable analgesia afterward, according to a systematic review and meta-analysis published online in the Brazilian Journal of Anesthesiology.

“Postoperative analgesia in abdominal surgery has been a subject of debate,” wrote Francisco Lucena Bezerra, MD, of Federal University of Rio Grande do Norte, and study coauthors. The authors also stated that “our meta-analysis seeks … to evaluate whether the analgesic effect of lidocaine is comparable to that of TEA, and to determine whether perioperative lidocaine infusion could serve as a viable alternative to TEA for abdominal surgeries.”

Analyzing Analgesic Effect

With the aim of updating a previous 2-study meta-analysis, the authors first conducted a systematic search on Embase, Web of Science, Cochrane Library, and PubMed using the following inclusion criteria: adult patients undergoing abdominal surgeries, perioperative lidocaine infusion, thoracic epidural analgesia, and pain scores assessment.

Of 1,261 screened studies, researchers selected and analyzed results from 6 randomized clinical trials involving 437 patients. They discovered that at 2 hours and 24 hours after surgery, pain relief at rest on a pain scale of 0 to 10 was better with TEA compared with lidocaine. The 2-hour mean difference in pain scores was –0.72 in favor of TEA across 335 patients; the 24-hour mean difference was –0.18 in favor of TEA across 402 patients, according to the study.

At 48 and 72 hours, however, there were no statistically significant differences in pain scores at rest.

For pain relief during coughing, TEA was superior at 24 hours after surgery, with a mean difference in pain scores of –0.36 across 360 patients, the study found. Pain during coughing did not differ significantly between interventions at 48 and 72 hours.

Postoperative nausea and vomiting, time to first flatus, and length of hospital stay did not significantly differ between patients who received TEA and those who received IV lidocaine.

Finding a Balance

“TEA provides superior pain control in the early postoperative period, while intravenous lidocaine achieves comparable analgesia after the first day,” the authors concluded, adding, “These findings hold particular relevance within ERAS [Enhanced Recovery After Surgery] protocols, in which a balance between optimal analgesia and early postoperative recovery is essential. The choice between TEA and intravenous lidocaine should be guided by clinical circumstances, patient-specific factors, and institutional resources.”