A Potential Role of Intraoperative Lidocaine in Patients Undergoing Thyroidectomy-An Original Systematic Review and...

Thyroidectomy is a routine operation for diverse thyroid diseases between benign and malignant. In such cases, the complications and postoperative pains, such as nausea, vomiting, and hemodynamic instability, complicate recovery and lengthen hospital stays. Lidocaine may prove beneficial due to its analgesic, anti-inflammatory, and antihyperalgesic actions. The current systematic review and meta-analysis assessed the effect of IV lidocaine infusion on postoperative pain and its complications in patients undergoing total thyroidectomy.

A systematic review of published RCTs between 2016 and 2023 was conducted using PubMed, Embase, and Google Scholar. Their inclusion criteria were the comparison of IV lidocaine versus placebo in managing patients undergoing thyroidectomy. The primary outcomes included postoperative pain by VAS measurements. Secondary outcomes included MAP, heart rate at extubation, and PONV. A random effects model was applied for the analysis, whereas statistical evaluation was done using RevMan 5.2.

A total of five RCTs of 375 patients were summarized, where 172 patients were in the lidocaine group and 203 in the placebo group. Significant reduction in postoperative pain of IV lidocaine was shown (SMD = -1.24; 95% CI: -2.7 to 0.30; I² = 97%, p = 0.11), heterogeneity was also reduced in a sensitivity analysis with I² = 46%. Extubation MAP and heart rate were also significantly lower (SMD for MAP = -1.27, p = 0.47; SMD for heart rate = -1.36, p = 0.11). PONV did not show any difference, whereas cough scores were remarkably improved (RR = 0.42, 95% CI = 0.28 to 0.63).

IV lidocaine shows potential in reducing postoperative pain, improving hemodynamic stability, and decreasing cough incidence in thyroidectomy patients. However, its effect on PONV remains unclear, warranting further investigation.