Intravenous Lidocaine in Non-Opioid Multimodal Perioperative Pain Management: Current Controversy and Future Perspectives

Abstract

In the perioperative setting, intravenous lidocaine moderately reduces postoperative pain, opioid consumption and inflammatory response. Under laboratory conditions, lidocaine has been shown to inhibit cancer cell behaviour and exerts beneficial effects on components of the inflammatory and immune responses that are known to affect cancer biology. New evidence suggests that it might minimize the impact of surgery on NK cells and could augment NK cell cytotoxicity and improve survival in patients after pancreatic oncosurgery. Given the narrow therapeutic index, potential toxicity and inconclusive evidence about its Enhanced Recovery After Surgery benefits, however, currently intravenous lidocaine is not routinely use for perioperative pain control. It should be administered after considering with the patient of its clear benefits over risks, in a dose of 1-2 mg/kg/h, not more than 24 hours and under a high dependency unit monitoring. Patients groups where the risk-benefit balance is tilted towards benefit include patients who are already on high doses of opioids, intolerant of opioids, and those who are at high risk of chronic postoperative pain. The upcoming role for intravenous lidocaine in oncosurgery might shift its place from a second line non-opioid adjuvant to a first line option in the context of improving oncological outcomes.