BACKGROUND Pain management following spine surgery remains a challenge. The significant use of opioids may lead to opioid-related adverse events. These complications can increase perioperative morbidity and rapidly expend health care resources by developing chronic pain. Although intraoperative pain control for surgery has been studied in the literature, a thorough assessment of the effect in spine surgery is rarely reported. The objective of the present study was to examine the outcomes of intraoperative intravenous lidocaine and intrawound or epidural bupivacaine use in spine surgery. METHODS An electronic literature search was conducted for studies on the use of lidocaine and bupivacaine in spine surgery for all years available. Only articles in English language were included. Postoperative opioid consumption, VAS score, nausea/vomiting, and length of hospital stay comprised the outcomes of interest. Pooled descriptive statistics with Risk Ratios (RR), Mean Differences (MD) and 95 % confidence interval were used to synthesize the outcomes for each medication. RESULTS A total of 10 studies (n = 579) were included in the analysis. Comparison of the opioid consumption revealed a significant mean difference between lidocaine and bupivacaine (MD: -12.25, and MD: -0.4, respectively, p = 0.01), favoring lidocaine. With regard to postoperative VAS, the pooled effect of both groups decreased postoperative pain (MD: -0.61 (95 % CI: -1.14, -0.08)), with a more significant effect in the lidocaine group (MD: -0.84, (95 % CI: -1.21, -0.48)). There was no significant effect in length of stay, and postoperative nausea/vomiting. CONCLUSIONS The results of the present meta-analysis indicate that lidocaine and bupivacaine use may decrease postoperative pain and opioid consumption. Lidocaine had a stronger effect on the reduction of opioid consumption compared to bupivacaine.

中文翻译：

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“静脉注射利多卡因与伤口内注射或硬膜外注射布比卡因对脊柱手术术后阿片类药物减少的镇痛作用：系统评价和荟萃分析”

背景脊柱手术后的疼痛管理仍然是一个挑战。阿片类药物的大量使用可能导致阿片类药物相关的不良事件。这些并发症会增加围手术期的发病率，并通过发展慢性疼痛迅速消耗医疗资源。尽管文献中已经研究了手术中的术中疼痛控制，但很少报道对脊柱手术效果的彻底评估。本研究的目的是检查术中静脉注射利多卡因和伤口内或硬膜外使用布比卡因在脊柱手术中的结果。方法 对所有可用年份中利多卡因和布比卡因在脊柱手术中使用的研究进行了电子文献检索。仅包括英文文章。术后阿片类药物消耗量、VAS 评分、恶心/呕吐、住院时间和住院时间包括感兴趣的结果。使用风险比 (RR)、平均差异 (MD) 和 95% 置信区间的汇总描述性统计数据来综合每种药物的结果。结果 共有 10 项研究（n = 579）被纳入分析。阿片类药物消耗量的比较显示，利多卡因和布比卡因之间存在显着的平均差异（MD：-12.25 和 MD：-0.4，p = 0.01），利多卡因更受欢迎。在术后 VAS 方面，两组的综合效应降低了术后疼痛（MD：-0.61（95 % CI：-1.14，-0.08）），利多卡因组的效果更显着（MD：-0.84，（95 % CI: -1.21, -0.48))。对住院时间和术后恶心/呕吐没有显着影响。结论 本荟萃分析的结果表明，利多卡因和布比卡因的使用可减少术后疼痛和阿片类药物的消耗。与布比卡因相比，利多卡因对减少阿片类药物消耗的影响更大。