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Lidocaine lubricants for intubation-related complications: a systematic review and meta-analysis

  • Alan Hsi-Wen Liao
  • Shang-Ru Yeoh
  • Yu-Cih Lin
  • Fai Lam
  • Ta-Liang Chen
  • Chien-Yu ChenEmail author
Reports of Original Investigations
  • 47 Downloads

Abstract

Purpose

Postoperative sore throat (POST) is a relatively common morbidity. Topical lidocaine lubricants have been proposed to prevent POST; however, their effectiveness remains uncertain. This meta-analysis aimed to evaluate the prophylactic effect of lidocaine lubrications against POST, cough, and hoarseness in adult patients after surgery.

Methods

Randomized-controlled trials from PubMed, Embase, the Cochrane Library, and the ClinicalTrials.gov registry that were published from inception until 26 March 2018 were included that compared the effectiveness of lidocaine lubricants with that of controls in preventing the incidence of overall POST and moderate to severe POST (POSTMS) at the first and 24th postoperative hour (POST-1h, POST-24h, POSTMS-1h, and POSTMS-24h). Postoperative cough and hoarseness at the 24th postoperative hour were also studied. Bias assessment and subgroup, sensitivity, and trial sequential analyses were also performed.

Results

Fourteen randomized-controlled trials (n = 2146) were selected. The incidences of POST-1h and POST-24h were 41.1 % and 22.6 % for the lidocaine group, and 41.9% and 23.5% for the control group, respectively. No effect was found on any of the outcome measurements. The overall risk ratios were 1.11 (95% confidence interval [CI], 0.82 to 1.51) and 1.06 (95% CI, 0.37 to 3.02) for the incidence of POST-1h and POSTMS-1h, respectively; 0.99 (95% CI, 0.83 to 1.17) and 0.49 (95% CI, 0.16 to 1.50) for POST-24h and POSTMS-24h, respectively; and, 1.09 (95% CI, 0.71 to 1.66) and 0.91 (95% CI, 0.66 to1.24) for postoperative cough (PC)-24h and postoperative hoarseness (PH)-24h, respectively.

Conclusion

Lidocaine lubricants applied on the tips of endotracheal tube are not effective against the morbidities of POST, PC, and PH.

Trial registration

PROSPERO (CRD42017073259); registered 26 October, 2017.

Les lubrifiants à base de lidocaïne pour la prévention des complications liées à l’intubation : une revue systématique et méta-analyse

Résumé

Objectif

Les maux de gorge postopératoires sont une morbidité relativement fréquente. Les lubrifiants topiques à base de lidocaïne ont été proposés pour prévenir les maux de gorge postopératoires, mais leur efficacité demeure incertaine. Cette méta-analyse avait pour objectif d’évaluer l’effet prophylactique des lubrifications de lidocaïne contre les maux de gorge postopératoires, la toux et l’enrouement de la voix chez les patients adultes après une chirurgie.

Méthode

Nous avons inclus les études randomisées contrôlées publiées sur PubMed, Embase, la Cochrane Library et le registre de ClinicalTrials.gov entre leur création et le 26 mars 2018 qui comparaient l’efficacité des lubrifiants à base de lidocaïne par rapport à l’absence de traitement pour prévenir l’incidence des maux de gorge postopératoires globaux et des maux de gorge postopératoires modérés à graves à la première et à la vingt-quatrième heure postopératoire (POST-1h, POST-24h, POSTMS-1h, et POSTMS-24h). La toux et l’enrouement à 24 heures postopératoires ont également été étudiés. Des analyses d’évaluation du biais et de sous-groupe, de sensibilité et des analyses séquentielles d’essais ont également été réalisées.

Résultats

Quatorze études randomisées contrôlées (n = 2146) ont été sélectionnées. Les incidences de POST-1h et de POST-24h étaient de 41,1 % et 22,6 % dans le groupe lidocaïne, et de 41,9 % et 23,5 % dans le groupe témoin, respectivement. Aucun effet n’a été observé pour aucun de nos critères d’évaluation. Les rapports de risque globaux étaient de 1,11 (intervalle de confiance [IC] 95 %, 0,82 à 1,51) et de 1,06 (IC 95 %, 0,37 à 3,02) pour l’incidence de POST-1h et de POSTMS-1h, respectivement; de 0,99 (IC 95 %, 0,83 à 1,17) et de 0,49 (IC 95 %, 0,16 à 1,50) pour les POST-24h et POSTMS-24h, respectivement; et de 1,09 (IC 95 %, 0,71 à 1,66) et 0,91 (IC 95 %, 0,66 à 1,24) pour la toux postopératoire (PC)-24h et l’enrouement postopératoire (PH)-24h, respectivement.

Conclusion

Les lubrifiants à base de lidocaïne appliqués sur l’extrémité distale du tube endotrachéal ne sont pas efficaces pour prévenir les morbidités de maux de gorge, de toux et d’enrouement postopératoires.

Enregistrement de l’étude

PROSPERO (CRD42017073259); enregistrée le 26 octobre 2017.

Notes

Conflicts of interest

None declared.

Editorial responsibility

This submission was handled by Dr. Hilary P. Grocott, Editor-in-Chief, Canadian Journal Anesthesia.

Author contributions

Alan Hsi-Wen Liao and Shang-Ru Yeoh contributed to all aspects of this manuscript, including study conception and design; acquisition, analysis, and interpretation of data; and drafting the article. Chien-Yu Chen and Ta-Liang Chen contributed to the conception and design of the study. Yu-Cih Lin contributed to the acquisition of data. Yu-Cih Lin and Fai Lam contributed to the analysis of data. Fai Lam contributed to the interpretation of data.

Funding

Department of Anesthesiology, Taipei Medical University Hospital.

Supplementary material

12630_2019_1408_MOESM1_ESM.pdf (130 kb)
Electronic supplementary material 1 (PDF 130 kb)

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Copyright information

© Canadian Anesthesiologists' Society 2019

Authors and Affiliations

  1. 1.Department of AnesthesiologyTaipei Medical University HospitalTaipeiTaiwan
  2. 2.School of Nursing, College of NursingTaipei Medical UniversityTaipeiTaiwan
  3. 3.Institute of Public Health, College of Public HealthTaipei Medical UniversityTaipeiTaiwan
  4. 4.Department of Anesthesiology, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
  5. 5.Department of AnesthesiologyWan Fang Hospital, Taipei Medical UniversityTaipeiTaiwan

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