Effectiveness of intravenous lidocaine in treatment of burn pain: a systematic review and meta-analysis of randomzed controlled trials.
Burns are among the most agonizing injuries encountered in the clinical setting. Protocols for effective management of burn pain vary and mostly rely on opioids, a drug class well-known for dependence and adverse effects from misuse. Lidocaine, the most commonly used local anesthetic, has shown potential to reduce the amount of opioids required. This study aims to assess the effectiveness of lidocaine infusion in reducing opioid use in patients with burn injuries. This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search of the electronic databases was carried out using the keywords "lidocaine," "lignocaine," "xylocaine," "burn," and "analgesia." Eligible studies were randomized controlled trials (RCTs) from peer-reviewed journals or registries. Two independent reviewers conducted the screening. The Cochrane Risk of Bias-2 tool was used to assess the quality of the included studies. Meta-analysis was conducted using Revman software. We included four RCTs with 152 burn patients with the total body surface area burned ranging from 3% to 68%. Morphine use had a standardized mean difference (SMD) of -0.47 (-1.18 to 0.24), which was not significant ( = 0.19). The changes in pain score were not significant [SMD = -0.01, confidence interval (CI) = (-0.37; 0.34), = 0.94]. Nausea had an Risk ratio of 1.06 [CI = (0.80; 1.40), = 0.700]. No serious adverse event was reported. Our findings were inconclusive about the safety and effectiveness of lidocaine as an adjunct in the analgesia of burns and reducing the required opioid dosage. Large-scale clinical trials are needed.