NSCLC: lidocaine cream lowers pain during chest tube removal

  • Watanabe SN & al.
  • Reg Anesth Pain Med
  • 20 Nov 2019

  • curated by Kelli Whitlock Burton
  • Univadis Clinical Summaries
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Takeaway

  • Adding lidocaine cream to epidural anesthesia significantly reduced patients’ pain during chest tube removal after video-assisted thoracoscopic surgery (VATS) for lung cancer compared with placebo.

Why this matters

  • Lidocaine injection is the most commonly used anesthetic for postoperative chest tube removal, but the injection itself can be painful and ineffective in some patients.

Study design

  • Double-blind randomized trial.
  • 40 patients with NSCLC who underwent VATS received epidural anesthesia combined with either lidocaine cream (n=20) or a placebo (n=20) just before chest tube removal.
  • Pain was measured with a visual analog scale (VAS) and the PainVision system.
  • Funding: None disclosed.

Key results

  • Patients receiving lidocaine cream reported significantly less pain than the placebo group (median VAS, 2 vs 5 [P=.0002] and median PainVision score, 41.2 vs 296.7 [P<.0001>
  • For men, median VAS scores were significantly higher with placebo than lidocaine (5 vs 2; P=.0020), as were median PainVision scores (285 vs 44.5; P=.0001).
  • For women, the median PainVision scores were significantly higher with placebo than lidocaine (379.9 vs 37.25; P=.0161), but the median VAS scores were not significantly different between groups.

Limitations

  • Small, single-center study.
  • No data on pain decrease difference of lidocaine cream vs injection.