Effect of Continuous Local Anesthetic in Post-Cardiac Surgery Patients: A Systematic Review.

OBJECTIVE: The purpose of this review was to determine the effect of CLA infusion post cardiac surgery on pain, time to ambulation, severe adverse events, patient satisfaction, time to extubation, length of stay in the intensive care unit and in the hospital, total narcotic consumption, and pulmonary function. DESIGN: Systematic review with meta-analysis (PROSPERO CRD42014010188). METHODS: We searched the following electronic databases: the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; CINAHL; Allied and Complementary Medicine (AMED); and PsycINFO; as well as hand-searching cardiothoracic surgery and anesthetic journals and meeting abstracts. RESULTS: Ten eligible trials with a total of 546 participants were identified. Meta-analyses showed that CLA infusion significantly reduced the total mean visual analog pain score at 72 hours (mean difference [MD] = -14.31 mm, 95% confidence interval [CI] = -25.59 to -3.03); time to ambulation (MD = -2.81 hours, 95% CI = -5.23 to -0.4); morphine requirement (MD = -10.19 mg, 95% CI = -11.80 to -8.58) but did not reduce time to ambulate to chair (MD = -1.65 hours, 95% CI = -4.04 to 0.74); time to extubation (MD = -0.18 hours, 95% CI = -1.24 to 0.89); length of ICU stay (MD = 0.9 hours, 95% CI = -2.96 to 4.75); and hospital length of stay (MD = -0.59 days, 95% CI = -1.24 to 0.07). There were insufficient data to perform a meta-analysis on severe adverse events, patient satisfaction, or pulmonary function. CONCLUSIONS: CLA infusion after cardiac surgery reduces pain score at 72 hours, shortens time to ambulation, and reduces morphine consumption at 48 hours.