Author: Dawood Alatefi, et al.
BMC Anesthesiology. Published online May 30, 2026.
Intravenous lidocaine may improve recovery after thyroidectomy by reducing postoperative nausea and vomiting, modestly decreasing pain, and improving quality-of-recovery scores. However, the clinical importance of the pain reduction remains uncertain despite statistically significant results.
Study Design
This systematic review and meta-analysis included 11 randomized controlled trials involving 943 adults undergoing thyroidectomy.
The investigators compared perioperative intravenous lidocaine with normal saline placebo. Outcomes included:
- Postoperative pain through 48 hours
- Quality of recovery
- Postoperative nausea and vomiting
- Rescue antiemetic use
- Opioid consumption
- Additional analgesic use
- Duration of anesthesia
- Adverse effects
The evidence was considered moderate certainty for most outcomes, although the evidence for pain at eight hours was rated as low certainty.
Key Findings
Intravenous lidocaine was associated with lower postoperative pain scores at 1, 4, 12, 24, and 48 hours.
At 24 hours, pain favored lidocaine, but there was substantial variability among the included studies. A smaller benefit remained at 48 hours.
Although these differences were statistically significant, the authors cautioned that the magnitude of pain improvement may not always be clinically meaningful.
Quality of Recovery
Patients receiving intravenous lidocaine had better quality-of-recovery scores on both the first and second postoperative days.
The average improvement was approximately:
- 6 points on postoperative day 1
- 6.5 points on postoperative day 2
These findings suggest that lidocaine may improve broader aspects of postoperative recovery beyond pain alone.
Postoperative Nausea and Vomiting
Intravenous lidocaine significantly reduced postoperative nausea and vomiting.
The risk of PONV was approximately 54% lower with lidocaine than with placebo. This was one of the more consistent findings, with little variation among the included trials.
Despite the reduction in PONV, the requirement for rescue antiemetic medication did not differ significantly between groups.
Other Outcomes
The duration of anesthesia was similar between the lidocaine and control groups.
The abstract did not demonstrate a clear clinically important reduction in postoperative opioid consumption or establish that lidocaine should replace other components of multimodal analgesia.
Clinical Implications
Thyroidectomy is commonly associated with pain, nausea, vomiting, and impaired early recovery. Intravenous lidocaine may be a useful component of a multimodal perioperative strategy, particularly in patients at increased risk for PONV.
The most persuasive potential benefit may be the reduction in nausea and vomiting and improvement in overall recovery rather than a large analgesic effect.
Lidocaine infusions should still be administered using appropriate dosing, monitoring, and patient selection because excessive systemic exposure can cause neurologic and cardiovascular toxicity.
Limitations
The included trials varied in lidocaine dosing, infusion duration, anesthetic techniques, pain measurement, and postoperative care.
There was substantial heterogeneity in the 24-hour pain analysis, which reduces confidence in the consistency of that result.
The manuscript was released as an unedited early-access version and may undergo corrections before final publication.
Conclusion
Perioperative intravenous lidocaine was associated with reduced postoperative pain, a lower incidence of nausea and vomiting, and improved quality of recovery after thyroidectomy.
The reduction in PONV appears clinically promising, but the analgesic benefit was modest and should be interpreted cautiously. Larger, standardized trials are needed to identify the most effective dosing regimen and determine which patients are most likely to benefit.
We thank BMC Anesthesiology for allowing us to summarize this important clinical research.