Comparative Analysis of Lidocaine vs. Bupivacaine for Local Anesthesia in Minor Surgical Procedures: A Meta-Analysis

Background: Local anesthetics such as lidocaine and bupivacaine are the most commonly employed in simple surgical operations, but their relative efficacy is controversial. This systematic review and meta-analysis aimed to perform a comparative analysis of the local anesthesia agents, lidocaine and bupivacaine in minor surgical operations. This review was aimed at facilitating evidence-based clinical decision-making in the choice of the most effective anesthetic to use when applying minor surgical practice. Methods: A search for lidocaine versus bupivacaine in minor surgical procedures was conducted in PubMed, Scopus, Web of Science, and Google Scholar for randomized controlled trials (RCTs). The studies were filtered in accordance with PRISMA 2020 criteria. The Cochrane tool was used to measure risk of bias, and the certainty of evidence was measured with GRADE. RevMan 5.4.1 was used to perform meta-analyses through random-effects models, subgroup and sensitivity analyses to test the robustness. Results: 12 RCTs were included. Quantitative data on onset were available in eleven studies, and duration in seven. No statistically significant difference in onset between lidocaine and bupivacaine was observed in a pooled analysis (SMD -0.27; 95% CI -0.70 to 0.16; I2 =92%). Contrarily, duration of anesthesia preferred bupivacaine (SMD -2.47; 95% CI: -3.16 to -1.79; I2 = 85%), and the findings were strong regardless of sensitivity analyses. The risk of bias was low-to medium-moderate, and the general evidence certainty was moderate. Discussion: Lidocaine has a better onset, and bupivacaine, a better analgesia, which validates their complementary roles in clinical indications. The two agents were safe, and intertrial heterogeneity demonstrates the necessity of standard protocols and multicenter, large-scale studies that could help guide an evidence-based anesthetic choice in the minor surgery practice.