<p>Carotid endarterectomy (CEA) is commonly performed to prevent ischemic stroke in patients with significant carotid stenosis but is linked to perioperative blood pressure instability. Intracarotid lidocaine injection has been proposed to improve postoperative hemodynamic stability, but evidence of its efficacy and safety remains mixed. We conducted a meta-analysis of randomized controlled trials (RCTs) assessing the intraoperative intracarotid injection of local anesthetics in CEA, following PRISMA guidelines. Primary outcomes included postoperative blood pressure variability, adverse cardiovascular events, and overall complication rates. Secondary outcomes assessed mortality and incidence of restenosis in the short and long term. Seven RCTs comprising 652 patients were included, with lidocaine as the most commonly used anesthetic. No statistically significant differences were found in postoperative hypotension (OR 1.31, 95% CI 0.62–2.76), hypertension (OR 1.03, 95% CI 0.5–2.15), or mean blood pressure (MD 4.12&#xa0;mmHg, 95% CI -3.35–11.60). Additionally, postoperative rates of arrhythmias (OR 1.22, 95% CI 0.7–2.12), myocardial infarction (OR 2.03, 95% CI 0.08–54.6), overall complications (OR 1.41, 95% CI 0.74–2.66), and cerebrovascular accidents (OR 2.55, 95% CI 0.61–10.57) did not differ significantly between groups. Intraoperative intracarotid injection of local anesthetic shows no significant benefit for stabilizing postoperative blood pressure in CEA patients. This meta-analysis did not support the hypothesized reduction in carotid sinus sensitivity. However, the small sample size increases the risk of type II error, and long-term outcomes, especially restenosis rates, require further investigation.</p>