Lidocaine 5% Patch for Treatment of Acute Pain After Robotic Cardiac Surgery and Prevention of Persistent Incisional Pain: A Randomized, Placebo-Controlled, Double-Blind Trial

Abstract

OBJECTIVES: To test the hypotheses that lidocaine 5% patches decrease the severity of acute pain and incidence of persistent incisional pain after robotic cardiac valve surgery. DESIGN: A randomized, placebo-controlled, double-blind trial. SETTING: Tertiary care academic medical center. SUBJECTS: Patients having robotic cardiac valve surgery. METHODS: Patients having robotic cardiac valve surgery were randomly assigned to 5% lidocaine patches or identical-appearing placebo patches. Patches were applied around each incision 12 hours/day until pain resolved, or for 6 months. Supplemental opioid was provided by patient-controlled analgesia or orally. Pain was initially evaluated with a Visual Analog Scale, and subsequently by telephone with a Verbal Response Scale and the Pain Disability Index (our primary outcome) after 1 week, 1 month, 3 months, and 6 months. Global Perceived Effect, a measure of patient satisfaction, was simultaneously recorded. Repeated-measures analysis of variance and generalized estimating equations were our primary statistical tools. RESULTS: Acute pain scores and opioid use were low, as was the incidence of persistent pain. Lidocaine 5% patches did not influence any measure of acute or persistent incisional pain. Estimated difference (95% CI) in mean Pain Disability Index for Lidocaine patch minus placebo was -2.5 (95% CI -7.1, 2.1), P = 0.28. CONCLUSIONS: Lidocaine 5% patches did not reduce acute or persistent pain in patients having robotic thoracic surgery, though pain scores were low in both treatment groups. Clinicians should choose alternative analgesic approaches in these patients.