Home›Rheumatology› Perioperative IV lidocaine cuts chronic postsurgical pain at 3 months but not 6 months
Perioperative IV lidocaine cuts chronic postsurgical pain at 3 months but not 6 monthsLidocaine during surgery may reduce chronic pain after operations
Frontiers in MedicinePublished September 28, 2026DOI ↗Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease
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Key Takeaway
Consider perioperative IV lidocaine for short-term CPSP reduction, but 6-month benefit is unproven.
This systematic review and meta-analysis evaluated whether perioperative intravenous lidocaine reduces chronic postsurgical pain in adults. The analysis included 1,391 adults and assessed CPSP incidence at 3 and 6 months postoperatively, with neuropathic pain risk as a secondary outcome.
At 3 months, perioperative intravenous lidocaine significantly reduced CPSP incidence compared with placebo or standard care (RR=0.67; 95% CI: 0.53 to 0.85; P=0.001). Neuropathic pain risk at 3 months was also significantly reduced (RR=0.60; 95% CI: 0.43 to 0.85; P=0.004).
At 6 months, the reduction in CPSP incidence was not statistically significant (RR=0.68; 95% CI: 0.41 to 1.12; P=0.13). The authors state that evidence of an effect on CPSP incidence at 6 months remains inconclusive.
Safety data were limited by inconsistent adverse-event reporting, and the review notes limited pharmacokinetic monitoring. Serious adverse events, discontinuations, and tolerability were not reported. Funding and conflicts of interest were not reported.
The findings support a possible short-term benefit of perioperative intravenous lidocaine for reducing CPSP at 3 months, but the durability of this effect beyond 3 months is uncertain. Clinicians should weigh the short-term signal against the limited safety reporting and the inconclusive 6-month results.
How this fits prior evidence
This meta-analysis extends prior coverage of lidocaine's analgesic role beyond procedural pain, where intrauterine lidocaine reduced IUD insertion pain and a lidocaine-esketamine infusion reduced movement-evoked pain and opioid use after hepatic resection. It also contrasts with prior anesthesia-focused findings, such as propofol outperforming sevoflurane and midazolam for delayed neurocognitive recovery, by addressing a longer-term pain outcome. The 3-month CPSP reduction is consistent with lidocaine's broader analgesic signal, but the non-significant 6-month result and inconsistent adverse-event reporting highlight that durability and safety remain unresolved compared with the more established short-term benefits seen in prior coverage.
Living with chronic pain after a surgery can be a long and difficult road for many patients. New data suggests that giving lidocaine through an IV during the operation might help some people avoid this lasting pain.
Researchers looked at data from 1,391 adults to see how this treatment worked. They found that patients who received lidocaine during surgery had a significantly lower risk of developing chronic postsurgical pain at the three-month mark. The study also showed a lower risk of developing neuropathic pain, which is pain caused by nerve damage, at that same three-month point.
While the three-month results were promising, the evidence for the six-month mark was not clear. Because of inconsistent reporting on side effects, it is hard to say exactly how well the treatment was tolerated. Talk to your doctor to see if this approach fits your specific surgical plan.
What this means for you:
Lidocaine during surgery may reduce chronic pain at three months, but results at six months are not yet clear.
Common questions
Does lidocaine help with pain after surgery?
Yes, the study found that giving lidocaine through an IV during surgery significantly reduced the risk of chronic postsurgical pain at the three-month mark. It also significantly reduced the risk of neuropathic pain, which is pain caused by nerve damage, at that same three-month point.
How long does the benefit of lidocaine last?
The benefit was clearly seen at three months after surgery. However, the evidence for whether it still helps at the six-month mark is not conclusive. Because of this, the long-term effects are not yet fully clear.
Is lidocaine safe to use during surgery?
The study did not report any serious adverse events. However, the researchers noted that reporting on side effects was inconsistent, making it hard to fully determine the treatment's tolerability. You should discuss safety with your doctor.
BackgroundChronic postsurgical pain (CPSP) poses a significant clinical burden, yet the efficacy of perioperative intravenous lidocaine for its prevention remains inconclusive. This meta-analysis evaluates its preventive efficacy and administration regimens.MethodsPubMed, EMBASE, and the Cochrane Library were searched from database inception to a prespecified cutoff of June 1, 2025; final electronic searches were run on June 8, 2025, to identify randomized controlled trials (RCTs) comparing perioperative intravenous lidocaine with placebo/standard care in adults. Primary outcomes were CPSP incidence at 3 and 6 months postoperatively.ResultsEighteen RCTs (1,391 patients) were included. Intravenous lidocaine significantly reduced CPSP incidence (RR = 0.67; 95% CI: 0.53 to 0.85; P = 0.001) and neuropathic pain risk (RR = 0.60; 95% CI: 0.43 to 0.85; P = 0.004) at 3 months. However, the reduction in the incidence of CPSP was not statistically significant at 6 months (RR = 0.68; 95% CI: 0.41 to 1.12; P = 0.13). Exploratory subgroup analyses of CPSP incidence at 3 months showed favorable pooled estimates in selected surgery and administration-regimen categories; however, they did not demonstrate a statistically significant difference between regimen categories. Safety assessment was limited by inconsistent adverse-event reporting and limited pharmacokinetic monitoring.ConclusionPerioperative intravenous lidocaine reduces CPSP at 3 months, but evidence of an effect on CPSP incidence at 6 months remains inconclusive. Future trials should incorporate structured pharmacokinetic monitoring and exposure-response analyses and evaluate lidocaine's additive value alongside optimal regional anesthesia.Systematic Review RegistrationPROSPERO, https://www.crd.york.ac.uk/PROSPERO/view/CRD420251063756, identifier CRD420251063756.
