• Kuo-Chuan Hung, Chin-Chen Chu, Chung-Hsi Hsing, Yang-Pei Chang, Yu-Yu Li, Wei-Cheng Liu, I-Wen Chen, Jen-Yin Chen, and Cheuk-Kwan Sun.
• Department of Anesthesiology, Chi Mei Medical Center, Tainan city, Taiwan.
• J Clin Anesth. 2021 Dec 1; 75: 110521.

Study ObjectiveTo evaluate the impact of perioperative intravenous lidocaine on the quality of recovery (QoR) following surgery.DesignMeta-analysis of randomized controlled trials (RCTs).SettingPostoperative care.InterventionIntravenous lidocaine during perioperative period.PatientsAdults undergoing surgery under general anesthesia.MeasurementsThe primary outcome was postoperative QoR measured with QoR-40 questionnaire, while the secondary outcomes included five individual dimensions (i.e., emotional, state, physical comfort, psychological support, physical independence, and pain) of QoR-40, intraoperative opioid consumption, and risk of chronic postsurgical pain (CPSP).Main ResultsMedline, Cochrane Library, Google scholar, and EMBASE databases were searched from inception to June 2021. Fourteen RCTs involving 1148 patients in total undergoing elective surgery published from 2012 to 2021 were included. QoR-40 scores were evaluated at postoperative 24 h (12 trials), 72 h (one trial), and Day 5 (one trial), respectively. Pooled results revealed significantly higher global [mean difference (MD) = 9.65, 95% confidence interval (CI): 6.33 to 12.97; I2 = 97%; 13 RCTs; n = 1085] and individual dimension QoR-40 scores in the lidocaine group than those in placebo group. Subgroup analysis demonstrated no significant impact of the type of surgery, age, gender, surgical time, anesthetic technique, lidocaine dosage, and time of assessment on global QoR-40 scores. The use of intravenous lidocaine was associated with a significant reduction in intraoperative remifentanil consumption compared with that in the placebo group (standardized MD = -0.91, 95%CI: -1.32 to -0.51; I2 = 86%; 10 RCTs; n = 799). There was no difference in risk of CPSP between the two groups [relative risk (RR) = 0.65, 95%CI: 0.33 to 1.25; I2 = 58%; 4 RCTs; n = 309].ConclusionOur results verified the efficacy of intravenous lidocaine for enhancing postoperative quality of recovery by using a validated subjective tool and reducing intraoperative remifentanil consumption in patients receiving elective surgery under general anesthesia. Further studies are warranted to verify its efficacy in the acute care setting.Copyright © 2021 Elsevier Inc. All rights reserved.

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