Systemic lidocaine in surgical procedures: effects beyond sodium channel blockade

This review presents current data on the systemic administration of lidocaine. The focus is on studies in the perioperative setting. In addition, there is a brief look at experimental data on the effect of lidocaine at the molecular level.

Several recent randomized prospective studies have reported lower postoperative pain values and less opioid administration in lidocaine groups in comparison with control groups receiving NaCl. However, there are conflicting data particularly in relation to patients undergoing nonabdominal surgery and on effects on postoperative resumption of bowel motility and hospital discharge times. Unfortunately, hardly any studies have investigated the effects of systemic lidocaine in comparison with epidural anesthesia. At the molecular level, a number of receptors and signal transduction cascades have been identified.

Positive effects on postoperative pain, as well as on bowel motility and hospital discharge time, have regularly been observed. However, contradictory findings have also been published. As almost all of the studies only include very small patient numbers, large multicenter investigations are needed.