Pretreatment with lidocaine reduces both incidence and severity of etomidate-induced myoclonus: a meta-analysis of randomized controlled trials

Bingchen Lang, Lingli Zhang, Chunsong Yang, Yunzhu Lin, Wensheng Zhang, Fengshan Li, Bingchen Lang, Lingli Zhang, Chunsong Yang, Yunzhu Lin, Wensheng Zhang, Fengshan Li

Abstract

Objective: One conundrum that frequently occurs during clinical anesthesia is etomidate-induced myoclonus, which results in multiple risks. The aim of the study was to evaluate systematically the effect of pretreatment with lidocaine on preventing etomidate-induced myoclonus.

Materials and methods: The literature search was performed from the inception to April 2018 in PubMed, Embase, Cochrane Library, and China National Knowledge Infrastructure. All randomized controlled trials that used lidocaine to prevent etomidate-induced myoclonus were enrolled. The primary outcome included the incidence and severity of etomidate-induced myoclonus. The data were combined to calculate the risk ratio and relevant 95% CI. A meta-analysis was performed following the guidelines of the Cochrane Reviewer's Handbook and the Preferred Reporting Items for Systematic Reviews and Meta Analyses statement.

Results: A total of eight studies were enrolled, and the existing evidence indicated that 1) pretreatment with lidocaine can reduce the incidence of etomidate-induced myoclonus (the incidence of myoclonus: 37.6% in lidocaine vs 73.6% in saline, risk ratio =0.46, with 95% CI [0.34, 0.63], P<0.0001); 2) the pretreatment with lidocaine can reduce the incidence of mild, moderate, and severe myoclonus; 3) a dose of pretreatment with lidocaine cannot significantly decrease the duration of myoclonus compared to placebo; 4) the administration of lidocaine produced no effect on the stable hemodynamic parameters and no more additional adverse effects.

Conclusion: Pretreatment with lidocaine could be served as one effective approach to decrease both the incidence and the severity of etomidate-induced myoclonus, with limited influence on the hemodynamic stability of patients. However, to confirm precise safety and efficacy of such intervention, more high-quality evidence is necessary.

Keywords: etomidate; lidocaine; meta-analysis; myoclonus.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flow chart of literature screening and the selection process. Abbreviation: RCT, randomized controlled trial.
Figure 2
Figure 2
Risk of bias assessment of included studies. Notes: Green + dot, low risk of bias; yellow ? dot, unclear risk of bias; red - dot, high risk of bias.
Figure 3
Figure 3
Forest plot of weighed RR. Note: The lidocaine group and saline control group in the prevention of etomidate-induced myoclonus with a 95% CI. Abbreviation: RR, risk ratio.
Figure 4
Figure 4
Forest plot of weighed RR. Note: Results of the lidocaine group and saline control group in terms of reduction of the severity of etomidate-induced myoclonus with a 95% CI: mild myoclonus. Abbreviation: RR, risk ratio.
Figure 5
Figure 5
Forest plot of weighed RR. Note: Results of the lidocaine group and saline control group in terms of the reduction of the severity of etomidate-induced myoclonus with a 95% CI: moderate myoclonus. Abbreviation: RR, risk ratio.
Figure 6
Figure 6
Forest plot of weighed RR. Note: Results of the lidocaine group and saline control group in terms of reduction of the severity of etomidate-induced myoclonus with a 95% CI: severe myoclonus. Abbreviation: RR, risk ratio.
Figure 7
Figure 7
Forest plot of weighed RR. Note: The effect of lidocaine in reducing the duration of myoclonus. Abbreviation: RR, risk ratio.

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