title: 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: OBJECTIVE
  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.
  
  
  METHODS
  A randomized, placebo-controlled, double-blind trial.
  
  
  METHODS
  Tertiary care academic medical center.
  
  
  METHODS
  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.
authors.affiliation: Department of Pain Management, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Bruce
authors.initials: B
authors.lastname: Vrooman
authors.affiliation: Carolinas Pain Institute at Brookstown, Wake Forest University, School of Medicine, Winston-Salem, North Carolina, USA.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Kapural
authors.affiliation: Department of Family Medicine, University Hospitals of Cleveland, Cleveland, Ohio, USA.
authors.forename: Sheryar
authors.initials: S
authors.lastname: Sarwar
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.|Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Mascha
authors.affiliation: Department of Cardiothoracic Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Tomislav
authors.initials: T
authors.lastname: Mihaljevic
authors.affiliation: Department of Cardiothoracic Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Marc
authors.initials: M
authors.lastname: Gillinov
authors.affiliation: Resident, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Shahbaz
authors.initials: S
authors.lastname: Qavi
authors.affiliation: Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Sessler
mesh_terms: D059787:Acute Pain; D000368:Aged; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D004185:Disability Evaluation; D004311:Double-Blind Method; D005260:Female; D006351:Heart Valves / Q000601:surgery; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D017060:Patient Satisfaction; D012371:Robotics; D057968:Transdermal Patch
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; C511998:Lidoderm; D008012:Lidocaine
keywords: Anesthesia; Lidocaine 5% Patch; Post-Thoracotomy Pain