Systemic anti-inflammatory effects of intravenous lidocaine in surgical patients: a systematic review and meta-analysis

Abstract

BACKGROUND There has recently been increasing evidence that the use of peri-operative intravenous lidocaine infusion possesses analgesic, opioid-sparing and anti-inflammatory effects in surgical patients. Although opioid sparing and analgesic properties have been strongly supported, the anti-inflammatory features are not well established in elective surgery. Therefore, the aim of this systematic review is to examine the effect of peri-operative intravenous lidocaine infusion on postoperative anti-inflammatory status in patients undergoing elective surgery. METHODS A search strategy was created to identify suitable randomized clinical trials (RCTs) in PubMed, Scopus, Web of Science and Clinicaltrials.gov databases until January 2023. RCTs that evaluated the effect of intravenous lidocaine infusion, compared with placebo, on adult patients who underwent elective surgery, in inflammatory markers response were included. Exclusion criteria consisted of pediatric patients, animal studies, non-RCT methodology, intervention without IV lidocaine, inadequate control group, duplicated samples, ongoing studies and lack of any relevant clinical outcome measures. The following inflammatory markers IL-6, TNF-α, IL-1RA, IL-8, IL-10, CRP, IL-1, IL-1β, IFN-γ, cortisol, IL-4, IL-17, HMGB1 and TGF-β were evaluated as outcomes in this review. RESULTS: A total of 21 studies, including 1254 patients, were identified. Intravenous lidocaine infusion significantly reduced the change from IL-6 baseline levels at the end of surgery compared to a placebo (standardized mean difference [SMD]: -0.647, 95% confidence interval [CI]: -1.034 to -0.260). Usage of lidocaine was associated with a significant reduction in other postoperative pro-inflammatory markers, such as TNF-α, IL-1RA, IL-8, IL-17, HMGB-1 and CRP. There was no significant difference in other markers, such as IL-10, IL-1β, IL-1, IFN-γ, IL-4, TGF-β and cortisol. CONCLUSIONS This systematic review and meta-analysis provides support for the administration of peri-operative intravenous lidocaine infusion as an anti-inflammatory strategy in elective surgery.