Intravenous Lidocaine in Video-Assisted Thoracoscopic Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

In 30 seconds

This systematic review and meta-analysis assessed intravenous lidocaine in video-assisted thoracoscopic surgery (VATS), including 9 randomized controlled trials with 672 patients. Lidocaine did not reduce postoperative morphine consumption at 24 or 48 hours or improve pooled movement pain scores at those time points. It reduced intraoperative remifentanil requirements in four trials, without better postoperative analgesia. Five trials (n = 360) found a significant reduction in postoperative nausea and vomiting (PONV), with negligible heterogeneity. The authors conclude that lidocaine may reduce PONV but does not improve postoperative pain or opioid consumption after VATS.

Key findings

• Five trials (n = 328) found no reduction in postoperative morphine consumption at 24 hours; three trials (n = 242) found no reduction at 48 hours.
• Pooled movement pain scores at 24 and 48 hours showed no significant difference between groups (3 trials, n = 200 each).
• Four trials (n = 272) reported lower intraoperative remifentanil requirements, without improved postoperative analgesia.
• Five trials (n = 360) found a significant reduction in PONV with negligible heterogeneity.

Why it matters

The findings distinguish lidocaine’s potential antiemetic benefit from its lack of demonstrated postoperative analgesic or opioid-sparing benefit in VATS. This helps frame expectations when evaluating it as an adjunct to multimodal perioperative care, while highlighting that reduced intraoperative opioid requirements do not necessarily translate into better postoperative pain outcomes.

What to keep in mind

The review notes small trial samples, varied lidocaine regimens and background analgesia, and incomplete reporting of inflammatory and pulmonary outcomes, limiting confidence in effect estimates.