231: Intravenous Lidocaine and Chronic Postsurgical Pain: A Systematic Review and Meta-Analysis

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic postsurgical pain, Pharmacological treatments, Assessment and Measurement of Pain/Nociception, Treatment/management

Background and Aims: Chronic postsurgical pain (CPSP) is pain that develops or increases following surgery, persists ≥3 months after surgery, and is not attributable to other causes.¹The median incidence at 6-12 months is approximately 20-30%, with incidence rising alongside high-risk surgical procedures and inflammatory disease.²Intravenous (IV) lidocaine has emerged as a potential preventive strategy due to its anti-nociceptive effects, including modulation of central sensitization.³In chronic pain populations, lidocaine infusions have demonstrated analgesia at plasma concentrations of 2–3 mg/mL.⁴However, evidence for its efficacy in preventing CPSP remains heterogeneous across surgical populations and dosing regimens, warranting a focused synthesis.

Methods: This systematic review followed a PROSPERO protocol (CRDXXXXXXXXXXXX). Embase, MEDLINE, and Web of Science were searched on 16 January 2026 without language restrictions. Randomized controlled trials (RCTs) in adult surgical patients (≥18 years) evaluating perioperative intravenous lidocaine (bolus and/or infusion) were included. Trials involving paediatric populations, pre-existing surgical-site pain, or non-systemic lidocaine were excluded. The primary outcome was incidence of CPSP measured with validated instruments. Secondary outcomes included pain severity at later time points, neuropathic pain, chronic opioid use, and health-related quality of life. Data will be pooled using random-effects meta-analysis with effect estimates and 95% confidence intervals.

Results: Across 19 RCTs, a total of 812 patients received lidocaine infusion, 734 patients received placebo or saline control, and 249 patients received alternative comparators. Most trials were double-blind (95%) and enrolled adults undergoing breast (37%), abdominal (26%), thoracic (11%), orthopedic (11%), and other surgical procedures (16%) across multiple regions. Lidocaine was administered as an intraoperative bolus followed by continuous infusion in all studies. CPSP was most commonly assessed at 3 months (84%), with fewer studies reporting 6-month (42%) or 12-month outcomes (11%). Data extraction is ongoing, and final pooled estimates of CPSP outcomes will be presented at the meeting.

Conclusions: CPSP represents a substantial clinical burden, yet evidence supporting preventive pharmacologic strategies remains heterogeneous. IV lidocaine is biologically plausible and widely used perioperatively, but uncertainty persists regarding its effectiveness and safety in reducing CPSP across surgical populations and dosing regimens. This systematic review is designed to provide an updated and methodologically rigorous synthesis to help inform perioperative analgesic strategies.

References: 1. Schug, S. A., Lavand’homme, P., Barke, A., Korwisi, B., Rief, W., Treede, R.-D., & IASP Taskforce for the Classification of Chronic Pain. (2019). The IASP classification of chronic pain for ICD-11: Chronic postsurgical or posttraumatic pain. Pain, 160(1), 45–52. https://doi.org/10.1097/j.pain.0000000000001413
2. Rosenberger, D. C., Pogatzki-Zahn, E. M., & Kehlet, H. (2022). Chronic post-surgical pain: Update on incidence, risk factors and preventive treatment options. BJA Education, 22(5), 190–196.https://doi.org/10.1016/j.bjae.2021.11.008
3. Onyeaka, H., Adeola, J., Xu, R., Pappy, A. L., Adeola, S., Smucker, M., Chang, A., Fraga, A., Ufondu, W., Osman, M., Hasoon, J., & Orhurhu, V. J. (2024). Intravenous lidocaine for the management of chronic pain: A narrative review of randomized clinical trials. Psychopharmacology Bulletin, 54(3), 73–96. https://doi.org/10.64719/pb.4495
4. Bailey, M., Corcoran, T., Schug, S., & Toner, A. (2018). Perioperative lidocaine infusions for the prevention of chronic postsurgical pain: A systematic review and meta-analysis of efficacy and safety. Pain, 159(9), 1696–1704. https://doi.org/10.1097/j.pain.0000000000001273

Presenting Author: Simrit Rana
Submitting Author: Simrit Rana

Senior Author: Dr. Narinder Singh

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• Zaim Khan: Bachelor's Degree - McMaster University
• Kevin Lee: Master's Degree - University of Toronto
• Ishaq Siddiqui: Bachelor's Degree - McMaster University
• Narinder Singh: Doctor of Medicine - Veer Surendra Sai Institute of Medical Sciences and Research