Perioperative intravenous lidocaine infusion for reduction of chronic postsurgical pain: A systematic review and meta-analysis.

Abstract

Objective: To assess perioperative intravenous lidocaine’s effectiveness in reducing chronic and acute postoperative pain, opioid use, and adverse events versus control. Study Design: Systematic review and meta-analysis. Setting: Department of Anesthesiology and Perioperative Medicine, through a systematic review of RCTs identified from PubMed, Cochrane CENTRAL, and Web of Science. Period: Jan 2015 to 2026. Methods: Studies published between January 2015 and May 07, 2026 that met the inclusion criteria were included. A total of 16 studies were included in the final analysis. Data analysis was conducted using RevMan 5.4. Results: Perioperative intravenous lidocaine significantly reduced chronic postsurgical pain at ≥3 months compared with control (RR = 0.33, 95% CI: 0.18–0.60, p = 0.0003; I² = 0%). Acute postoperative pain at 24 hours was also significantly reduced (MD = -0.69, 95% CI: -1.26 to -0.12, p = 0.02; I² = 61%), with greater benefit in studies using Visual Analog Scale outcomes (MD = -0.96, 95% CI: -1.31 to -0.62, p < 0.00001). No significant reduction in opioid consumption was observed (MD = -1.06, 95% CI: -2.46 to 0.35, p = 0.14; I² = 97%). No significant increase in cardiovascular or neurological adverse events was found (RR = 0.55, 95% CI: 0.21–1.43, p = 0.22). Conclusion: Perioperative intravenous lidocaine significantly reduces chronic postsurgical pain and improves early postoperative analgesia without increasing adverse events, supporting its role in multimodal perioperative pain management.