Intravenous Lidocaine Improves quality of Recovery After Thyroidectomy, finds study

A new study published in the journal of BMC Anesthesiology found that in patients having thyroidectomy, intravenous (IV) lidocaine was linked to better quality of recovery (QoR), less nausea and vomiting, and lower postoperative pain levels.

Thyroidectomy is linked to postoperative pain and postoperative nausea and vomiting (PONV). Although IV lidocaine has been suggested as a part of multimodal analgesia, its effectiveness and safety in thyroidectomy patients are yet unknown. Thus, this meta-analysis and systematic review assessed the safety and effectiveness of perioperative IV lidocaine in this cohort.

This systematic search until August 13, 2025, using PubMed, Scopus, Web of Science, and the Cochrane Library in accordance with PRISMA principles was conducted. Randomized controlled studies (RCTs) that compared IV lidocaine with a placebo (normal saline) in adult patients having thyroidectomies were included. Postoperative pain ratings at 1, 4, 8, 12, 24, and 48 hours were the main outcome.

Quality of recovery ratings, PONV incidence, antiemetics usage, anesthesia duration, total postoperative opioid intake, and postoperative analgesia use were secondary outcomes. Random-effects models were used for meta-analyses. When there was high or significant heterogeneity (I² > 40%), the Hartung–Knapp–Sidik–Jonkman (HKSJ) approach was employed; when there was low to moderate heterogeneity (I² < 40%), the DerSimonian and Laird (DL) technique was utilized.

An analysis of 11 randomized controlled trials involving 943 patients evaluated the efficacy of intravenous lidocaine. IV lidocaine dramatically decreased postoperative pain assessments at 1, 4, 12, 24, and 48 hours when compared to controls; this was mostly supported by moderate-certainty evidence. Also, on postoperative days 1 and 2, lidocaine-treated patients showed noticeably better Quality of Recovery.

Additionally, the total incidence of postoperative nausea and vomiting was significantly reduced by the intervention. Nevertheless, neither the overall length of anesthesia nor the requirement for rescue antiemetic medication were considerably changed by the administration of IV lidocaine. In the end, these results demonstrate IV lidocaine as a useful supplement for enhancing recovery and comfort following surgery.

Overall, intravenous lidocaine has been related to reduced postoperative pain, nausea and vomiting, and improved quality of recovery in thyroid surgery patients. However, because mathematical statistics proving pain reduction does not always transfer into significant patient alleviation, the actual real-world impact of its pain-relieving capabilities must be carefully assessed.

Source:

Alatefi, D., Saeed, O., Alkabazi, M., Gamal, I., Alanzi, A., Alfeetouri, M. Y., Benfaid, N. A., Shata, A., AbdElfattah, M. A., Wagdy, M., Mohammed, S. E., & Elhadi, M. (2026). Efficacy and safety of intravenous lidocaine in thyroidectomy: a systematic review and meta-analysis with trial sequential analysis and meta-regression. BMC Anesthesiology. https://doi.org/10.1186/s12871-026-03965-y