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Background <p>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.</p> Methods <p>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 <i>I</i><sup>2</sup> for heterogeneity, and sensitivity analyses were performed.</p> Results <p>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&#xa0;h, 95% CI − 21.87 to − 3.43), and decreased time to first flatus (MD = − 7.08&#xa0;h, 95% CI − 12.85 to − 1.31). Pain scores at 24&#xa0;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&#xa0;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.</p> Conclusions <p>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.</p> Graphical abstract <p></p>

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Perioperative intravenous lidocaine for gastrointestinal recovery and pain control in elective colorectal surgery: a systematic review and updated meta-analysis of randomized controlled trials

  • 期刊论文

  • 发表日期：

    2026年8月5日

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  • Maria Eduarda Caetano Batista de Paiva,
  • Francisco José Lucena Bezerra,
  • Lucas Teixeira Baldo,
  • Denis Maltz Grutcki,
  • Alice Oliveira de Almeida,
  • Vinícius Fernandes Sarmento,
  • Matheus Arraes

摘要

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.

Graphical abstract