Muntean C, Ardelean MV, Gaborean V, Faur IF, Faur AM , et al.
Journal of clinical medicine •
major open abdominal surgery remains associated with clinically important postoperative pain, delayed gastrointestinal recovery, opioid exposure, and prolonged length of stay. Intravenous lidocaine infusion (IVLI) has biologically plausible analgesic, anti-hyperalgesic, anti-inflammatory, and opioid-sparing effects, but prior evidence syntheses have often combined open and minimally invasive procedures. This systematic review evaluated evidence for perioperative IVLI in adult patients undergoing major open abdominal surgery. the review was structured according to PRISMA 2020. The final search was run on 15 January 2026 and covered PubMed/MEDLINE, Embase, Cochrane CENTRAL, Scopus, Web of Science Core Collection, ClinicalTrials.gov, and WHO ICTRP from database inception to that date, without language restrictions at the search stage. Eligible studies enrolled adults undergoing elective open abdominal surgery and compared systemic IVLI with placebo, usual care, or active epidural analgesic comparators. Primary outcomes were postoperative opioid consumption and pain intensity. Secondary outcomes included gastrointestinal recovery, postoperative ileus, length of hospital stay, postoperative nausea and vomiting, inflammatory/stress biomarkers, and adverse events. ten randomized trials involving 658 participants were included. Placebo/usual-care trials and active-comparator trials were synthesized separately because they address different clinical questions. IVLI generally reduced opioid consumption compared with placebo, with extractable effects including a 55.9 mg reduction in 72 h morphine use in one abdominal surgery trial and a 13.9 mg reduction in 24 h morphine use after radical prostatectomy. Gastrointestinal recovery favored IVLI in most placebo-controlled studies; for example, first flatus occurred 12.5 h earlier and first bowel movement 28.4 h earlier in one trial. Active-comparator trials suggested comparable early dynamic pain outcomes versus thoracic epidural analgesia in selected settings, although opioid consumption findings were less consistent. No serious lidocaine-related toxicity was reported, but the included trials were underpowered to detect rare local anesthetic systemic toxicity events and did not consistently capture subclinical neurologic symptoms such as perioral numbness or visual disturbance. in adult open abdominal surgery, perioperative IVLI may provide opioid-sparing and recovery benefits, particularly when infusion continues beyond the intraoperative period. However, the certainty of evidence remains limited.
Popa GM, Abu-Awwad SA, Abu-Awwad A, Pop NO, Pop P , et al.
Metabolites •
The perioperative period in cancer surgery is characterized by transient metabolic and inflammatory perturbations that may influence early postoperative biochemical dynamics. Surgical stress induces insulin resistance, hyperglycemia, cytokine activation, and metabolic shifts that interact with tumor cell signaling pathways. Intravenous lidocaine has been associated with anti-inflammatory and systemic stabilizing effects beyond analgesia. We investigated whether perioperative lidocaine administration during robotic-assisted radical prostatectomy (RARP) is associated with early postoperative prostate-specific antigen (PSA) dynamics within the context of perioperative metabolic-inflammatory modulation. In this single-center retrospective cohort study, 180 patients undergoing RARP for localized or locally advanced prostate cancer were stratified according to perioperative intravenous lidocaine exposure. The primary endpoint was undetectable PSA (<0.1 ng/mL) at 6-12 weeks postoperatively. Secondary endpoints included PSA detectability at 3 and 6 months and time to first detectable PSA. Multivariable logistic and Cox regression models were adjusted for established oncologic risk factors. Perioperative glycemic variation, intraoperative lactate dynamics, and postoperative IL-6 levels were analyzed as indicators of stress-induced metabolic activation. Lidocaine exposure was independently associated with higher odds of undetectable PSA at 6-12 weeks (OR 2.10, 95% CI 1.15-3.85) and at subsequent time points. In Cox analysis, lidocaine was associated with a reduced hazard of PSA detectability (HR 0.58, 95% CI 0.37-0.92). Patients receiving lidocaine demonstrated significantly attenuated perioperative hyperglycemia, lower lactate elevation, and reduced IL-6 response. Perioperative intravenous lidocaine administration during RARP was associated with more favorable early PSA dynamics and attenuation of perioperative metabolic-inflammatory activation. Given the retrospective and non-randomized design of the study, these findings should be interpreted as associative and hypothesis-generating, and warrant confirmation in prospective controlled investigations.
Popa GM, Abu-Awwad SA, Abu-Awwad A, Marta CI, Bimbo-Szuhai E , et al.
Medicina (Kaunas, Lithuania) •
: Effective perioperative pain management remains a key goal of enhanced recovery protocols, especially in minimally invasive urologic surgery, where optimizing comfort while limiting opioid exposure is essential. Intravenous lidocaine has gained attention for its multimodal analgesic and anti-inflammatory properties, yet evidence in robotic prostatectomy remains limited. This study evaluated whether intraoperative lidocaine infusion was associated with lower early postoperative pain scores and reduced opioid use in patients undergoing robotic-assisted radical prostatectomy. : A retrospective, single-center analysis was conducted at Pelican Clinical Hospital, Oradea, Romania, including 112 patients operated on between January 2020 and December 2023. All procedures were performed by the same surgical and anesthetic teams using standardized ERAS-based protocols. Patients were divided into two groups: the Lidocaine Group (LG, = 51), who received a bolus of 1.5 mg/kg lidocaine followed by an infusion of 1.5 mg/kg/h during surgery, and the Control Group (CG, = 61), who received standard anesthesia without lidocaine. Postoperative pain was measured using the visual analog scale (VAS) at 0, 4, 12, and 24 h, and opioid use was converted into morphine milligram equivalents (MME). Secondary outcomes included time to ambulation, gastrointestinal recovery, oral intake, hospital stay, and complications. : Pain intensity was significantly lower in the lidocaine group at 4 h postoperatively (VAS 3.5 ± 1.1 vs. 4.3 ± 1.3; = 0.01), with similar scores later. Total opioid use was reduced by about 18% in the lidocaine group (25.7 ± 9.4 vs. 31.2 ± 10.5 MME; = 0.03). Recovery parameters and complication rates were comparable between groups, and no lidocaine-related adverse events were recorded. : Intraoperative intravenous lidocaine was associated with lower early postoperative pain scores and reduced opioid requirements after robotic-assisted radical prostatectomy without affecting recovery or safety. Its favorable profile and low cost support its inclusion as a practical adjunct in multimodal analgesia within ERAS pathways.
Popa GM, Abu-Awwad SA, Abu-Awwad A, Marta CI, Bimbo-Szuhai E , et al.
Medicina (Kaunas, Lithuania) •
: Surgical stress during robotic-assisted radical prostatectomy (RARP) elicits a measurable systemic inflammatory response despite the minimally invasive approach. Intravenous lidocaine has been increasingly investigated for its potential anti-inflammatory, analgesic, and immunomodulatory benefits, but evidence in robotic urologic oncology remains limited. This study aimed to evaluate whether intraoperative lidocaine infusion attenuates postoperative inflammation, improves analgesic outcomes, and accelerates early recovery following RARP. : This prospective non-randomized observational study included 80 patients undergoing elective RARP, divided into a Lidocaine Group ( = 40) receiving an intraoperative bolus and continuous infusion, and a Control Group ( = 40) receiving standard anesthesia without lidocaine. Serum IL-6, TNF-α, CRP, and fibrinogen were measured at baseline, end of surgery, and 24 h postoperatively. Postoperative pain scores, opioid consumption, gastrointestinal recovery, ambulation, and length of stay were recorded. Statistical analyses included repeated-measures ANOVA, correlation testing, and between-group comparisons. : Baseline characteristics were similar between groups. At 24 h postoperatively, lidocaine administration was associated with a significantly attenuated inflammatory response, with lower levels of IL-6 (45.7 ± 10.8 vs. 68.9 ± 12.6 pg/mL, < 0.01) and TNF-α (20.5 ± 5.1 vs. 27.2 ± 6.4 pg/mL, < 0.01) compared with controls. Patients receiving lidocaine reported lower postoperative pain scores and required significantly less opioid analgesia, with a total 24 h consumption of 8.9 ± 3.4 vs. 14.8 ± 5.2 mg morphine milligram equivalents ( < 0.001). Lidocaine was also associated with faster recovery, including earlier oral intake and a shorter length of hospital stay (2.9 ± 0.7 vs. 3.6 ± 0.9 days, = 0.003). No lidocaine-related adverse events were observed. : In this prospective observational study, intraoperative intravenous lidocaine was associated with attenuated early postoperative inflammation, improved analgesic outcomes, and enhanced early recovery following RARP. These findings support the potential role of intravenous lidocaine as a safe adjunct in multimodal perioperative management; however, given the non-randomized observational design, causal inferences should be interpreted with caution. Further randomized controlled trials are warranted to confirm causality and to validate long-term clinical and mechanistic effects. Potential residual confounding inherent to the observational design should be considered when interpreting these findings.