Perioperative intravenous lidocaine for the prevention of chronic postsurgical pain: a systematic review and meta-analysis of randomized controlled trials

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• Picked for Anesthesiology and Pain Medicine (paper of the day, 15 October 2026): IV lidocaine for prevention of chronic postsurgical pain meta‑analysis

Abstract

BACKGROUND: Chronic postsurgical pain (CPSP) poses a significant clinical burden, yet the efficacy of perioperative intravenous lidocaine for its prevention remains inconclusive. This meta-analysis evaluates its preventive efficacy and administration regimens. METHODS: PubMed, EMBASE, and the Cochrane Library were searched from database inception to a prespecified cutoff of June 1, 2025; final electronic searches were run on June 8, 2025, to identify randomized controlled trials (RCTs) comparing perioperative intravenous lidocaine with placebo/standard care in adults. Primary outcomes were CPSP incidence at 3 and 6 months postoperatively. RESULTS: Eighteen RCTs (1,391 patients) were included. Intravenous lidocaine significantly reduced CPSP incidence (RR = 0.67; 95% CI: 0.53 to 0.85; P = 0.001) and neuropathic pain risk (RR = 0.60; 95% CI: 0.43 to 0.85; P = 0.004) at 3 months. However, the reduction in the incidence of CPSP was not statistically significant at 6 months (RR = 0.68; 95% CI: 0.41 to 1.12; P = 0.13). Exploratory subgroup analyses of CPSP incidence at 3 months showed favorable pooled estimates in selected surgery and administration-regimen categories; however, they did not demonstrate a statistically significant difference between regimen categories. Safety assessment was limited by inconsistent adverse-event reporting and limited pharmacokinetic monitoring. CONCLUSION: Perioperative intravenous lidocaine reduces CPSP at 3 months, but evidence of an effect on CPSP incidence at 6 months remains inconclusive. Future trials should incorporate structured pharmacokinetic monitoring and exposure-response analyses and evaluate lidocaine's additive value alongside optimal regional anesthesia. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, https://www.crd.york.ac.uk/PROSPERO/view/CRD420251063756, identifier CRD420251063756.

Abstract as published, via PubMed.