• Michael Liu, Mabel Wai, and James Nunez.
• Michael Liu is the manager of clinical pharmacy services and director of the PGY-1 pharmacy residency program at Lawrence + Memorial Hospital, New London, Connecticut. Mabel Wai is a clinical pharmacist II of cardiothoracic surgery at the Heart & Vascular Center at Yale New Haven Hospital, New Haven, Connecticut. James Nunez is a clinical pharmacist II of cardiology services at Yale New Haven Hospital michael.liu@lmhosp.org.
• Crit Care Nurse. 2019 Oct 1; 39 (5): 51-57.

BackgroundTransdermal lidocaine patches have few systemic toxicities and may be useful analgesics in cardiac surgery patients. However, few studies have evaluated their efficacy in the perioperative setting. Objective To compare the efficacy of topical lidocaine 5% patch plus standard care (opioid and nonopioid analgesics) with standard care alone for postthoracotomy or poststernotomy pain in adult patients in a cardiothoracic intensive care unit.MethodsA single-center, retrospective cohort evaluation was conducted from January 2015 through December 2015 in the adult cardiothoracic intensive care unit at a tertiary academic medical center. Cardiac surgery patients with new sternotomies or thoracotomies were included. Patients in the lidocaine group received 1 to 3 topical lidocaine 5% patches near sternotomy and/or thoracotomy sites daily. Patches remained in place for 12 hours daily. Patients in the control group received standard care alone.ResultsThe primary outcome was numeric pain rating for sternotomy/thoracotomy sites. Secondary outcomes were cardiothoracic intensive care unit and hospital lengths of stay and total doses of analgesics received. Forty-seven patients were included in the lidocaine group; 44 were included in the control group. Mean visual analogue scores for pain did not differ between groups (lidocaine, 2; control, 1.9; P = .58). Lengths of stay were similar for both groups (cardiothoracic intensive care unit: lidocaine, 3.06 days; control, 3.11 days; P = .86; hospital: lidocaine, 8.26 days; control, 7.61 days; P = .47).ConclusionsAdjunctive lidocaine 5% patches did not reduce acute pain in postthoracotomy and post-sternotomy patients in the cardiothoracic intensive care unit.©2019 American Association of Critical-Care Nurses.

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