The effects of lidocaine intravenous infusion on postoperative pain and quality of recovery: What should we expect from a systematic review and Meta-analysis

Abstract

Background: Perioperative intravenous infusion of lidocaine has become part of multimode analgesia in opioid-free anesthesia, which can reduce postoperative pain and improve postoperative recovery quality. However, the results of this discussion are still in dispute. The purpose of this systematic review and meta-analysis was to determine the effect of intravenous lidocaine infusion on postoperative recovery quality and analgesic in adult patients undergoing general anesthesia. Methods: PubMed, EMBASE, Web of Science database, and Google Scholar were systematically searched for randomized controlled trials, regardless of language and publication platform. A total of 13 randomized controlled trials (1131 patients) were included. The primary outcome measures were the total Quality of Recovery (QoR-40) on the first postoperative day (POD1) and Visual Analogue Scale (VAS) and Numeric Rating Scale (NRS) at different postoperative time points. Secondary outcome measures were the incidence of postoperative nausea or vomiting, time to recovery of intestinal function, and length of hospital stay. Data extraction and bias risk assessment were conducted independently by two researchers. Results: Systemic intravenous infusion of lidocaine on the first postoperative day(POD1) significantly improved the quality of recovery(QoR-40)(WMD, weighted mean difference 4.98；95%CI, confidence interval 1.78 to 8.19；P value =0.002；heterogeneity, I2=63%), NRS pain scores were significantly decreased at rest and movement at 0.5 h postoperative（Rest status: WMD, -0.70; 95%CI:-1.05~-0.35; P=0.0001; I2=0%）（Movement status: WMD, -0.76；95%CI:-1.18~-0.34; P=0.0004; I2=9%）. There were no significant differences in VAS and NRS pain scores at other time points. Conclusions: Low-risk bias evidence suggests that intravenous lidocaine improves QoR-40 scores on the first day after general anesthesia and reduces postoperative pain during resuscitation. However, this conclusion needs to be further confirmed by a large number of high-quality randomized controlled trials.