Podcast Summary: Dr. Chapa’s OBGYN Clinical Pearls

Episode: Lido Patches After CS? Maybe.
Date: November 18, 2025
Host: Dr. Chapa
Theme: Evidence-based guidance on the use of lidocaine patches after Cesarean section (CS) for pain control

Episode Overview

This episode dives into the current literature examining the use of topical lidocaine patches as an adjuvant therapy for post-cesarean pain. Dr. Chapa reviews and compares four key systematic reviews and meta-analyses (2019, 2022, 2023, and the brand-new 2025 "Pink Journal" study) to clarify whether lidocaine patches reduce opioid use or improve patient satisfaction after CS. The tone is upbeat, practical, and candid, with Dr. Chapa's hallmark no-nonsense "no spin" clinical review style.

Key Discussion Points & Insights

Background on Lidocaine Patches

• Popular Use: Lidocaine patches are common for muscle aches and superficial pain (e.g., products advertised by Shaq, Salonpas, Biofreeze) but are now attracting attention in OB for CS pain control.
• Current Role: Not recommended as sole therapy post-CS, but as an adjuvant in the first 24–36 hours.
• Central Question: Do lidocaine patches reduce opioid use and/or improve patient satisfaction after CS?

Review of Major Studies

1. 2019 Systematic Review (Current Pain and Headache Reports)

• Scope: Transdermal Lidocaine for perioperative pain
• Findings:
  • Short-term benefit for post-op pain control
  • Unclear opioid reduction, unclear increased ambulation/function
• Conclusion: "If it can possibly help and it doesn't hurt and there's some evidence for it, why not?"
• Emoji summary: "meh" (10:42)
• Notable Quote:

  "2019, the emoji that summarizes lidocaine patches for post Caesarean pain control is meh. But it's not going to hurt. Nobody had had a complication from a lidocaine patch." — Dr. Chapa (10:53)

2. 2022 Meta-analysis (Koo et al, Journal of Clinical Anesthesia)

• Studies included: 11 RCTs
• Findings:
  • Decreased pain scores up to 48h
  • No significant reduction in morphine use at 24/48h
  • No increase in side effects
• Notable Quote:

  "Lidocaine patches absolutely lowered pain scores up to 48 hours, but, quote, did not significantly reduce morphine consumption at 24 or 48 hours. The good news was, is that there was no increase in local or systemic side effects from the patches. End quote." (11:54)

• Summary: Short-term pain relief only; no major impact on opioids, no new safety concerns

3. 2023 Meta-analysis (Wu et al, Clinical Journal of Pain)

• Studies included: 16 RCTs, 918 patients (various surgeries including CS)
• Findings:
  • Lower pain scores at 12–48 hours post-op
  • Some decrease in opioid (morphine) requirement in first 48h
  • No major improvement in overall patient satisfaction
• Notable Quote:

  "Yes, our goal should be to reduce narcotics. That's great. But overall, they're like, meh." (13:29)

• Takeaway: Slight improvement in early opioid use, but not enough to move the needle in satisfaction

4. 2025 Systematic Review & Meta-analysis (Pink Journal, Nov 2025)

• Studies included: 3 RCTs, 219 pregnancies
• Findings:
  • Lower pain scores at 12, 24, 36 hours post-CS
  • No difference in pain or opioid use after 48h
• Quote from study:

  "Based on this data, the use of lidocaine patches may be considered as part of a multimodal analgesia strategy after cesarean delivery." (15:31)

• Host’s Interpretation:
  • Helpful as an adjuvant in the first 48 hours, but not beyond
  • Should not be used as the only pain management method
• Practical Recommendation:

  "Maybe use this as a quality improvement project in your institution. Maybe get some data together. Talk with your anesthesia buddies..." (17:39)

Collective Synthesis

• All reviews reach a similar conclusion:
  • Short-term pain improvement (first 48h)
  • Little to no impact on opioid reduction or patient satisfaction
  • No adverse safety signals

Notable Quotes & Memorable Moments

• On limitations:

  "If somebody asks you, does topical lidocaine patches, does that have a role for post cesarean pain control? Absolutely...as an adjuvant, it can be used, although of course we know it's got some limitations, can't be used by itself. And past a certain cutoff, which traditionally seems to be about 48 hours, there's really no difference in the patient's use of narcotics or satisfaction after that point." — Dr. Chapa (09:26)

• On Motrin dosing:

  "Most patients underdose their Motrin ... 600 milligrams of Motrin or a maximum of 800 milligrams every eight hours with food is okay, but most patients will take, you know, 200 milligrams... That's not enough. You got a big old incision on your abdomen. You got to crank up those bad boys as long as you can tolerate that well." (10:00)

• On interpreting meta-analyses:

  "Whenever you read a meta analysis, guys, that's good ... But it's still only as good as what you put into it. And what you get out of it is what you put into it." (15:12)

• On bottom line recommendation:

  "The first 48, yes, lidocaine patches do work, even though after that, it kind of falls apart a little bit. And that's why, if you're going to do this, that's fine." (16:45)

Timestamps of Key Segments

| Time | Segment | |-----------|----------------------------------------------------------------------------------| | 00:49 | Introduction to lidocaine patches in CS pain control | | 03:00 | What studies have looked at, and the clinical questions being asked | | 09:00 | Dr. Chapa begins fast-tracking review of 2019, 2022, and 2023 systematic reviews | | 10:42 | Review of 2019 systematic review and its limited conclusions | | 11:54 | Findings from 2022 Koo et al meta-analysis | | 12:42 | 2023 Wu et al meta-analysis, extension to more RCTs | | 15:07 | Introduction to the latest (2025) Pink Journal study | | 15:31 | Direct reading of study conclusion | | 16:45 | Practical recommendation and commentary | | 17:39 | Suggestion for institutional QI projects and future directions |

Tone, Style, & Clinical Relevance

Dr. Chapa maintains his signature conversational, practical tone, peppered with humor ("meh emoji," asides about TV shows, and relatable clinical anecdotes). He is clear about the need to avoid overinterpretation of limited evidence, and highlights the continued need for opioid-sparing strategies and data-driven practice changes.

Summary Table

| Study (Year) | # of RCTs | Main Effects | Opioid Reduction | Satisfaction | Duration of Benefit | |------------------------------|-----------|----------------------|------------------|--------------|----------------------| | 2019 Systematic Review | Not stated| ↓ Short-term pain | Unclear | Unclear | <48H | | 2022 Koo et al (Meta-analysis)| 11 | ↓ Pain ≤48H | No | Not focused | <48H | | 2023 Wu et al (Meta-analysis)| 16 | ↓ Pain ≤48H | Yes, some | No | <48H | | 2025 Pink Journal (Meta-an.) | 3 | ↓ Pain ≤36H | No | No | <48H |

Take-Home Message

• Lidocaine patches may be considered after CS as part of a multimodal strategy.
• They reliably decrease pain scores in the first 48 hours, but do not significantly reduce opioid requirements or improve patient satisfaction beyond that.
• Use as an adjunct—not as a replacement, and be aware that individual patient response may vary.
• “Why not?” if it helps some and doesn’t harm—but don’t overpromise results based on current data.

Final Thoughts

Dr. Chapa closes by advocating for context-aware, team-based decision-making and conservative optimism regarding non-opioid modalities:

“Maybe use this as a quality improvement project in your institution. Maybe get some data together. Talk with your anesthesia buddies or those in SOAP, the Society of Obstetrical Anesthesia and Perinatal Providers, and see what they think. I think it's a good idea to try. I'm all for it, even though the benefit seems to be pretty short term.” (17:39)

This episode arms listeners with up-to-date, practical, and nuanced information about the real-world role of lidocaine patches after cesarean. For those considering implementation, it’s “yes, but—with realistic expectations.”