Intravenous Lidocaine in Video-Assisted Thoracoscopic Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
Effective postoperative recovery after video-assisted thoracoscopic surgery (VATS) remains a significant challenge, with patients frequently experiencing moderate to severe pain, pulmonary decline, and postoperative nausea and vomiting (PONV) despite modern multimodal analgesia. Intravenous lidocaine has been proposed as an opioid-sparing adjunct with systemic analgesic and antihyperalgesia properties, but its role in VATS is uncertain. This systematic review and meta-analysis identified a total of 31 studies, of which 9 randomized controlled trials involving 672 patients met the inclusion criteria and were included in the final quantitative and qualitative synthesis. Five trials (n = 328) assessing 24-hour opioid use and 3 trials (n = 242) assessing 48-hour use showed no reduction in postoperative morphine consumption with lidocaine. Similarly, pooled movement pain scores at 24 and 48 hours (3 trials, n = 200 each) demonstrated no significant difference between groups. Although 4 trials (n = 272) reported a marked reduction in intraoperative remifentanil requirements, this did not translate into improved postoperative analgesia. In contrast, lidocaine produced a consistently favorable antiemetic effect: 5 trials (n = 360) showed a significant reduction in PONV with negligible heterogeneity. Limitations included small sample sizes, varying bolus and infusion regimens, heterogeneity in background analgesic protocols, and incomplete reporting of outcomes such as inflammatory markers and pulmonary physiology, all of which reduce confidence in effect estimates. Overall, current evidence indicates that while intravenous lidocaine is safe and offers a reproducible reduction in PONV, it does not improve postoperative pain or opioid consumption following VATS. Larger, standardized trials are required to determine whether specific subgroups or dosing strategies may yield a greater benefit in thoracic minimally invasive surgery.