The Effectiveness of Perioperative Intravenous Lidocaine for Postoperative Analgesia in Video-Assisted Thoracic...

Acute pain after video-assisted thoracic surgery (VATS) remains a significant challenge. While intravenous lidocaine is increasingly used for analgesia, its efficacy for VATS remains uncertain. This meta-analysis aimed to evaluate the impact of perioperative intravenous lidocaine on postoperative pain in patients undergoing VATS.

We systematically searched PubMed, Web of Science, Embase, Cochrane Library, and Chinese databases (CNKI, WANFANG, SinoMed) from inception to December 31, 2025, for randomized controlled trials (RCTs) comparing intravenous lidocaine with placebo saline in adults undergoing VATS. Primary outcomes were static and dynamic pain scores. Secondary outcomes included opioid consumption, quality of recovery (QoR), postoperative nausea and vomiting (PONV), gastrointestinal recovery, postoperative pulmonary complications (PPCs), and length of hospital stay. Data were pooled using random-effects models. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Sixteen RCTs involving 1045 patients were included. Compared with placebo, intravenous lidocaine significantly reduced static pain scores at 6-8 h (MD -0.61 cm, 95% CI [-0.99, -0.24]), 24 h (MD -0.48 cm, 95% CI [-0.79, -0.17]), and 48 h (MD -0.31 cm, 95% CI [-0.48, -0.14]), as well as dynamic pain scores at the corresponding time points. However, the magnitude of pain reduction did not reach the predefined threshold for clinical importance (≥1 cm), and prediction intervals crossed the line of no effect for all pain outcomes. Intravenous lidocaine was also associated with reduced postoperative opioid consumption and improved QoR, although neither effect reached established minimal clinically important difference (MCID) thresholds. Additionally, lidocaine reduced PONV and accelerated gastrointestinal recovery. No significant effects were observed on PPCs or lidocaine-related adverse events, and it slightly prolonged the length of hospital stay. The certainty of evidence ranged from very low to moderate.

Although perioperative intravenous lidocaine infusion was associated with statistically significant improvements in postoperative pain and several recovery-related outcomes following VATS, the magnitude of benefit in pain, opioid consumption, and QoR did not consistently reach established thresholds for clinical importance. The certainty of evidence was generally low, and substantial heterogeneity was observed across studies. The overall clinical benefit of perioperative intravenous lidocaine remains uncertain and should be interpreted with caution.