Perioperative Intravenous Lidocaine Infusion Versus Placebo for Opioid Consumption Reduction in Abdominal Surgery: A Systematic Review and Meta-Analysis
Abstract
A systematic review and meta-analysis of randomised controlled trials evaluating intravenous lidocaine as a perioperative opioid-sparing adjunct in adult abdominal surgery.
Postoperative opioid consumption after abdominal surgery contributes to delayed recovery, nausea and the risk of long-term opioid dependence. Perioperative intravenous lidocaine infusion has been proposed as an opioid-sparing multimodal analgesic adjunct.
Following PRISMA 2020 guidance, the review searched PubMed, Embase, Cochrane CENTRAL, Web of Science and ClinicalTrials.gov from database inception to 15 March 2026. Eligible studies were randomised controlled trials comparing perioperative intravenous lidocaine infusion with placebo in adults undergoing open or laparoscopic abdominal surgery under general anaesthesia.
The primary outcome was cumulative postoperative opioid consumption expressed in morphine equivalents at 24 and 48 hours. Secondary outcomes included postoperative pain, gastrointestinal recovery, postoperative nausea and vomiting, hospital length of stay and adverse events.
Fifty-two randomised controlled trials involving 3,812 patients met the inclusion criteria, with 48 studies contributing to meta-analysis. Intravenous lidocaine reduced opioid consumption at both 24 and 48 hours and improved several secondary recovery outcomes.
Perioperative intravenous lidocaine demonstrated opioid-sparing, analgesic and recovery benefits in abdominal surgery, supporting its consideration as part of multimodal analgesia and enhanced recovery pathways. Variation in dosing regimens and moderate heterogeneity should be considered when interpreting the findings.
Randomised placebo-controlled trials.
Adults undergoing abdominal surgery.
Studies contributing quantitative data.
Trials conducted across international settings.
−8.7 mg Morphine Equivalents
Across 42 studies involving 2,956 participants, intravenous lidocaine reduced cumulative 24-hour opioid consumption by 8.7 mg morphine equivalents compared with placebo (95% CI −12.4 to −5.0; I² = 68%).
−11.2 mg Morphine Equivalents
At 48 hours, pooled opioid consumption was reduced by 11.2 mg morphine equivalents compared with placebo (95% CI −15.8 to −6.6; 28 studies; n = 2,104; I² = 72%).
Greater Effect in Open Surgery
Subgroup analysis demonstrated a larger opioid-sparing effect in open surgery, with a mean difference of −14.3 mg compared with −6.1 mg in laparoscopic procedures.
Postoperative Continuation Showed Greater Benefit
The opioid-sparing effect was greater in studies where intravenous lidocaine infusion continued postoperatively rather than being discontinued at the end of surgery.
−1.1 cm VAS at 1–4 Hours
Pain scores at rest and on movement were significantly reduced during the early postoperative period, with a pooled weighted mean difference of approximately −1.1 cm on the visual analogue scale at 1–4 hours.
−0.8 cm VAS
Pain reduction persisted at 24 hours, with an estimated weighted mean difference of −0.8 cm compared with placebo.
−0.5 cm VAS
A smaller but statistically significant reduction in pain remained evident at 48 hours after surgery.
RR 0.68
The incidence of postoperative nausea and vomiting was significantly lower with intravenous lidocaine (RR 0.68; 95% CI 0.54–0.86; 35 studies).
First Flatus 7.4 Hours Earlier
Intravenous lidocaine was associated with faster gastrointestinal recovery, reducing time to first flatus by approximately 7.4 hours.
11.2 Hours Earlier
Time to first bowel movement was reduced by approximately 11.2 hours compared with placebo.
0.6 Days Shorter
Hospital length of stay was reduced by approximately 0.6 days (95% CI −1.1 to −0.1).
Lidocaine Toxicity <1%
No significant difference in clinically important lidocaine-related toxicity was identified. Reported events were uncommon and mainly included transient dizziness and tinnitus; cardiac and neurological events were comparable.
Moderate for Primary Outcome
GRADE assessment rated evidence for the primary opioid consumption outcome as moderate, principally because of inconsistency across studies.
High-Quality Evidence
The quality of evidence relating to safety outcomes was rated high in the GRADE assessment.
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Systematic Review & Meta-Analysis
A quantitative evidence synthesis of randomised controlled trials evaluating perioperative intravenous lidocaine against placebo for opioid-sparing analgesia in adult abdominal surgery.
PRISMA 2020
The systematic review and meta-analysis was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement.
Not Prospectively Registered
The review was not prospectively registered in PROSPERO because of time constraints at study initiation. The author reports that a predefined protocol was developed and followed to support methodological transparency and reproducibility.
Up to 15 March 2026
The literature search covered database inception through 15 March 2026.
Five Major Databases & Trial Registry
Sources included PubMed, Embase, Cochrane CENTRAL, Web of Science and ClinicalTrials.gov. Grey literature, conference abstracts and reference lists were also searched.
4,872 Records Identified
The search identified 4,872 records. After duplicate removal, 3,214 records were screened, 312 full-text articles were assessed, 52 RCTs were included in the review and 48 contributed to meta-analysis.
Adults Undergoing Abdominal Surgery
Eligible participants were adults aged 18 years or older undergoing elective or emergency open or laparoscopic abdominal surgery under general anaesthesia.
IV Lidocaine Bolus + Infusion
Eligible intervention groups received perioperative intravenous lidocaine initiated before incision, typically using a bolus followed by continuous infusion. The comparator was placebo with 0.9% saline.
Random-Effects Models
RevMan 5.4 was used for meta-analysis. Weighted mean differences with 95% confidence intervals were calculated for continuous outcomes and risk ratios for dichotomous outcomes. Heterogeneity was quantified using I².
Cochrane RoB 2
Thirty-four studies were assessed as having low overall risk of bias, 12 had some concerns and six had high risk of bias, primarily related to allocation concealment.
GRADE
The GRADE approach was used to assess certainty of evidence. Evidence for the primary outcome was rated moderate because of inconsistency, while safety evidence was rated high.
Mild Funnel Plot Asymmetry
Funnel plots demonstrated mild asymmetry, although trim-and-fill adjustment did not materially alter the estimated treatment effects. Publication bias was assessed using funnel plots and Egger’s test when at least 10 studies were available.
Focused Contemporary Evidence Synthesis
Strengths identified by the author include the comprehensive search strategy, use of RoB 2 and GRADE, and a specific focus on abdominal surgery in the contemporary ERAS era.
Heterogeneity & Variable Regimens
Limitations include moderate statistical heterogeneity, variation in lidocaine dose and infusion duration, under-reporting of plasma lidocaine levels and the predominance of relatively small single-centre trials.
No Primary Participant Data
No new human or animal participant data were collected. Consequently, ethical approval and informed consent were not required for this systematic review and meta-analysis.
Sole Author
The author conceived, wrote, revised and approved the final manuscript.
Screening Verification & Academic Support
The author acknowledges Raphael Olayinka for assistance with partial verification of study screening and feedback during preparation of the manuscript, and acknowledges academic support from Benjamin Carson (Snr) College of Health and Medical Sciences.
Conflict of Interest & Funding
Conflict of Interest:
No conflict of interest.
Funding:
No funding received.
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DOI: 10.64573/torgj2604001
Volume 2 · Issue 2 · Special Issue · 2026
The Operating Room Global Journal (TORGJ).
ISSN 3105-3262.
Systematic Review and Meta-Analysis.
DOI: 10.64573/torgj2604001.
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