Perioperative lidocaine delivered intravenously (IV) may not improve pain, gastrointestinal recovery, postoperative nausea, or opioid consumption in the early postoperative phase compared with placebo or no treatment, according to results published in Cochrane Database of Systematic Reviews.

The review included 68 trials with 4525 participants. Two trials compared IV lidocaine with thoracic epidural analgesia, and the other 66 trials compared IV lidocaine with placebo or no treatment. The primary outcomes were pain score at rest, gastrointestinal recovery, and adverse events. Secondary outcomes were postoperative nausea and postoperative opioid consumption.

After reviewing the studies, it was unclear whether IV lidocaine improved postoperative pain compared with placebo or no treatment at early time points (1 to 4 hours) after surgery (standardized mean difference [SMD], −0.50, 95% CI, −0.72 to −0.28), equivalent to an average pain reduction of 0.37 cm to 2.48 cm on a 0- to 10-cm visual analog scale (a 1-cm difference on the scale is considered clinically meaningful).

The investigators did not find a clinically relevant reduction in pain with lidocaine at intermediate time points (24 hours) after surgery, with an average pain reduction between 0.10 cm and 0.48 cm (SMD, −0.14; 95% CI, −0.25 to −0.04). The same was true for later time points (48 hours) after surgery, with an average pain reduction between 0.08 cm and 0.42 cm (SMD, −0.11; 95% CI, −0.25 to 0.04).

It was unclear whether lidocaine reduced the risk for ileus (risk ratio, 0.37; 95% CI, 0.15-0.87), time to first defecation/bowel movement (mean difference, −7.92 hours; 95% CI, −12.71 to −3.13), risk for postoperative nausea (risk ratio, 0.78; 95% CI, 0.67-0.91), or opioid consumption (mean difference, −4.52 mg morphine equivalents; 95% CI, −6.25 to −2.79).

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The effects of IV lidocaine compared with thoracic epidural analgesia were unclear (pain at 24 hours: mean difference, 1.51; 95% CI, −0.29 to 3.32; pain at 48 hours: mean difference, 0.98; 95% CI, −1.19 to 3.16).

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Weibel S, Jelting Y, Pace NL, et al. Continuous intravenous perioperative lidocaine infusion for postoperative pain and recovery in adults. Cochrane Database Syst Rev. 2018;6:CD009642.