Research Article| Volume 42, ISSUE 12, P2311-2320, December 2020

The 5% Lidocaine Patch for Decreasing Postoperative Pain and Rescue Opioid Use in Sternotomy: A Prospective, Randomized, Double-blind Trial


      • Post-sternotomy pain (PSP) is one of the major postoperative complaints after cardiac surgery.
      • The 5% lidocaine patches were applied to the bilateral side of the sternotomy site.
      • The 5% lidocaine patch can reduce PSP and the use of additional opioids without causing significant adverse effects.



      Poststernotomy pain (PSP), a primary concern after sternotomy, can negatively affect patients' satisfaction with surgery and quality of life. Many clinical trials have been conducted to examine the usefulness of lidocaine patches (LPs) for postoperative pain control for multiple types of surgery; however, the results of these trials are inconsistent. In addition, little is known about the use of LPs after cardiac procedures that require sternotomy. This prospective, double-blind, placebo-controlled trial aimed to determine the efficacy of the 5% LP application at the sternotomy site for reducing PSP and rescue opioid consumption.


      The patients were randomly assigned to receive either the 5% LP or the placebo patch on each side of the incision site immediately after the surgery. The intensity of pain at 6, 12, 24, and 48 h after the patch application; the total dose of rescue opioids; incidence of nausea, vomiting, and sleep disturbance; and use of antiemetics were compared between the 2 groups.


      Fifty-seven (31 in the LP group and 26 in the placebo group) patients were included. The pain intensity was significantly lower in the LP group at each time point (66%–68% pain reduction, P < 0.001, interaction of time × treatment P = 0.69). In addition, the total dose of rescue opioids used for 48 h was significantly lower in the L group (27.2% reduction, P = 0.008). No significant differences were found in other outcome variables between the 2 groups.


      The application of a 5% LP on each side of the sternotomy site can reduce PSP and additional opioid use without significant adverse effects in patients undergoing sternotomy. Thus, it can be considered as a standard and routine modality along with other analgesic medications for the management of PSP. Clinical Trial Registry in South Korea identifier: KCT0000476.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Therapeutics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Lahtinen P.
        • Kokki H.
        • Hynynen M.
        Pain after cardiac surgery: a prospective cohort study of 1-year incidence and intensity.
        Anesthesiology. 2006; 105: 794-800
        • Thapa P.
        • Euasobhon P.
        Chronic postsurgical pain: current evidence for prevention and management.
        Korean J Pain. 2018; 31: 155-173
        • Kalso E.
        • Mennander S.
        • Tasmuth T.
        • Nilsson E.
        Chronic post-sternotomy pain.
        Acta Anaesthesiol Scand. 2001; 45: 935-939
        • Fregoso G.
        • Wang A.
        • Tseng K.
        • Wang J.
        Transition from acute to chronic pain: evaluating risk for chronic postsurgical pain.
        Pain Phys. 2019; 22: 479-488
        • McGreevy K.
        • Bottros M.M.
        • Raja S.N.
        Preventing chronic pain following acute pain: risk factors, preventive strategies, and their efficacy.
        Eur J Pain Suppl. 2011; 5: 365-372
        • Kamel E.Z.
        • Abd-Elshafy S.K.
        • Sayed J.A.
        • Mostafa M.M.
        • Seddik M.I.
        Pain alleviation in patients undergoing cardiac surgery; presternal local anesthetic and magnesium infiltration versus conventional intravenous analgesia: a randomized double-blind study.
        Korean J Pain. 2018; 31: 93-101
        • Chaudhary V.
        • Chauhan S.
        • Choudhury M.
        • Kiran U.
        • Vasdev S.
        • Talwar S.
        Parasternal intercostal block with ropivacaine for postoperative analgesia in pediatric patients undergoing cardiac surgery: a double-blind, randomized, controlled study.
        J Cardiothorac Vasc Anesth. 2012; 26: 439-442
        • El Shora H.A.
        • El Beleehy A.A.
        • Abdelwahab A.A.
        • et al.
        Bilateral paravertebral block versus thoracic epidural analgesia for pain control post-cardiac surgery: a randomized controlled trial.
        Thorac Cardiovasc Surg. 2018;
        • Kim K.H.
        • Seo H.J.
        • Abdi S.
        • Huh B.
        All about pain pharmacology: what pain physicinas should know.
        Korean J Pain. 2020; 33: 108-120
        • Attal N.
        • Cruccu G.
        • Baron R.
        • et al.
        EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision.
        Eur J Neurol. 2010; 17 (1113–e88)
        • Lee W.
        • Hahn K.
        • Hur J.
        • Kim Y.
        Effect of topical lidocaine patch on postoperative pain management in laparoscopic appendectomy: a randomized, double-blind, prospective study.
        J Laparoendosc Adv Surg Tech A. 2018; 28: 1061-1067
        • Lau L.L.
        • Li C.Y.
        • Lee A.
        • Chan S.K.
        The use of 5% lidocaine medicated plaster for acute postoperative pain after gynecological surgery: a pilot randomized controlled feasibility trial.
        Medicine (Baltimore). 2018; 97e12582
        • Habib A.S.
        • Polascik T.J.
        • Weizer A.Z.
        • et al.
        Lidocaine patch for postoperative analgesia after radical retropubic prostatectomy.
        Anesth Analg. 2009; 108: 1950-1953
        • Khanna M.
        • Peters C.
        • Singh J.R.
        Treating pain with the lidocaine patch 5% after total knee arthroplasty.
        PM R. 2012; 4: 642-646
        • Vrooman B.
        • Kapural L.
        • Sarwar S.
        • et al.
        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.
        Pain Med (Malden, Mass). 2015; 16: 1610-1621
        • Liu M.
        • Wai M.
        • Nunez J.
        Topical lidocaine patch for postthoracotomy and poststernotomy pain in cardiothoracic intensive care unit adult patients.
        Crit Care Nurse. 2019; 39: 51-57
        • Smoker J.
        • Cohen A.
        • Rasouli M.R.
        • Schwenk E.S.
        Transdermal lidocaine for perioperative pain: a systematic review of the literature.
        Curr Pain Headache Rep. 2019; 23: 89
        • Gammaitoni A.R.
        • Fine P.
        • Alvarez N.
        • McPherson M.L.
        • Bergmark S.
        Clinical application of opioid equianalgesic data.
        Clin J Pain. 2003; 19: 286-297
        • Saber A.A.
        • Elgamal M.H.
        • Rao A.J.
        • Itawi E.A.
        • Martinez R.L.
        Early experience with lidocaine patch for postoperative pain control after laparoscopic ventral hernia repair.
        Int J Surg. 2009; 7: 36-38
        • Wilcke J.R.
        • Davis L.E.
        • Neff-Davis C.A.
        • Koritz G.D.
        Pharmacokinetics of lidocaine and its active metabolites in dogs.
        J Vet Pharmacol Ther. 1983; 6: 49-57
        • Rowbotham M.C.
        • Davies P.S.
        • Verkempinck C.
        • Galer B.S.
        Lidocaine patch: double-blind controlled study of a new treatment method for post-herpetic neuralgia.
        Pain. 1996; 65: 39-44
        • Kumar M.
        • Chawla R.
        • Goyal M.
        Topical anesthesia.
        J Anaesthesiol Clin Pharmacol. 2015; 31: 450-456
        • Bai Y.
        • Miller T.
        • Tan M.
        • Law L.S.
        • Gan T.J.
        Lidocaine patch for acute pain management: a meta-analysis of prospective controlled trials.
        Curr Med Res Opin. 2015; 31: 575-581
        • Argoff C.E.
        Targeted topical peripheral analgesics in the management of pain.
        Curr Pain Headache Rep. 2003; 7: 34-38
        • Krumova E.K.
        • Zeller M.
        • Westermann A.
        • Maier C.
        Lidocaine patch (5%) produces a selective, but incomplete block of Aδ and C fibers.
        Pain. 2012; 153: 273-280
        • Gammaitoni A.R.
        • Alvarez N.A.
        • Galer B.S.
        Safety and tolerability of the lidocaine patch 5%, a targeted peripheral analgesic: a review of the literature.
        J Clin Pharmacol. 2003; 43: 111-117
        • Campbell B.J.
        • Rowbotham M.
        • Davies P.S.
        • Jacob 3rd, P.
        • Benowitz N.L.
        Systemic absorption of topical lidocaine in normal volunteers, patients with post-herpetic neuralgia, and patients with acute herpes zoster.
        J Pharm Sci. 2002; 91: 1343-1350
        • Joudrey S.D.
        • Robinson D.A.
        • Kearney M.T.
        • Papich M.G.
        • da Cunha A.F.
        Plasma concentrations of lidocaine in dogs following lidocaine patch application over an incision compared to intact skin.
        J Vet Pharmacol Ther. 2015; 38: 575-580
      1. ZTlido-a new lidocaine patch for postherpetic neuralgia.
        Med Lett Drugs Ther. 2019; 61: 41-43
        • Pastore M.N.
        • Kalia Y.N.
        • Horstmann M.
        • Roberts M.S.
        Transdermal patches: history, development and pharmacology.
        Br J Pharmacol. 2015; 172: 2179-2209
        • Fiorelli A.
        • Pace C.
        • Cascone R.
        • et al.
        Preventive skin analgesia with lidocaine patch for management of post-thoracotomy pain: results of a randomized, double blind, placebo controlled study.
        Thorac Cancer. 2019; 10: 631-641
        • Cheng Y.-J.
        Lidocaine skin patch (Lidopat® 5%) is effective in the treatment of traumatic rib fractures: a prospective double-blinded and vehicle-controlled study.
        Med Princ Pract. 2016; 25: 36-39