Perioperative intravenous lidocaine for gastrointestinal recovery and pain control in elective colorectal surgery: a systematic review and updated meta-analysis of randomized controlled trials
In brief
IV lidocaine cuts nausea by one third and speeds bowel return 13 hours
In a meta-analysis of 12 randomized trials involving 1,208 patients, peri-operative IV lidocaine reduced postoperative nausea and vomiting by about 34% and shortened time to first bowel movement by roughly 13 hours after laparoscopic or robotic colorectal surgery. It did not change rates of ileus, length of stay, or opioid use, so routine adoption remains uncertain.
- Journal
- Surgical endoscopy (Q1)
- Published
- 5 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Maria Eduarda Caetano Batista de Paiva, Francisco José Lucena Bezerra, Lucas Teixeira Baldo, Denis Maltz Grutcki, Alice Oliveira de Almeida, Vinícius Fernandes Sarmento, et al.
- PMID
- 42554867
- DOI
- 10.1007/s00464-026-13096-7
Why clinicians should know about it
- Picked for Anesthesiology and Pain Medicine (top studies of the week, 9 August 2026).
Abstract
BACKGROUND: Minimally invasive colorectal surgery, including laparoscopic and robotic techniques, has enhanced perioperative safety and recovery. However, postoperative gastrointestinal dysfunction remains frequent, delaying discharge and impairing outcomes. Intravenous lidocaine, owing to its analgesic and anti-inflammatory properties, has been proposed to improve recovery, but evidence remains inconsistent, especially after the retraction of a major trial. This updated systematic review and meta-analysis assessed the effects of perioperative intravenous lidocaine on gastrointestinal and clinical outcomes after minimally invasive colorectal resections. METHODS: A systematic search of PubMed, Embase, and Cochrane Central was performed through June 2025. Randomized controlled trials comparing intravenous lidocaine with placebo in adults undergoing laparoscopic or robotic colorectal surgery were included. Two reviewers independently screened studies, extracted data, and evaluated bias using the Cochrane RoB 2 tool. Pooled risk ratios (RR) and mean differences (MD) were calculated with I2 for heterogeneity, and sensitivity analyses were performed. RESULTS: Twelve RCTs involving 1208 patients (603 lidocaine, 605 placebo) met inclusion criteria. Lidocaine significantly reduced postoperative nausea and vomiting (RR = 0.66, 95% CI 0.45-0.97), shortened time to first bowel movement (MD = - 12.65 h, 95% CI - 21.87 to - 3.43), and decreased time to first flatus (MD = - 7.08 h, 95% CI - 12.85 to - 1.31). Pain scores at 24 h were lower (MD = - 1.61, 95% CI - 2.82 to - 0.41). No significant effects were observed for postoperative ileus (RR = 1.01, 95% CI 0.69-1.49), hospital stay (MD = - 0.37 days, 95% CI - 0.92 to 0.18), or opioid consumption (MD = 0.47, 95% CI - 10.39 to 11.32). Results remained robust despite moderate-to-high heterogeneity. CONCLUSIONS: Perioperative intravenous lidocaine modestly improves gastrointestinal recovery and early postoperative pain after minimally invasive colorectal surgery but does not affect ileus, hospital stay, or opioid use. Routine use should be considered cautiously pending further high-quality trials.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.