Daily PubMed evidence board
Efficacy and safety of intravenous lidocaine in thyroidectomy: a systematic review and meta-analysis with trial sequential analysis and meta-regression.
This systematic review and meta-analysis combined 11 randomized trials (943 adults) to evaluate whether giving intravenous lidocaine around the time of th…
Signal score70Research triage score
CertaintyModerate (per abstract; note pain at 8 h rated low-certainty in abstract)Verify in full text
PMID42218380Source identifier
Research triage, not medical advice
Do not use this summary, score, or benefit-cost estimate to diagnose, treat, prescribe, or change care without reviewing the full study and consulting qualified professionals.
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Check full-text methods, eligibility, outcomes, risk of bias, harms, conflicts, funding, replication, and applicability.
Plain-English signal
This systematic review and meta-analysis combined 11 randomized trials (943 adults) to evaluate whether giving intravenous lidocaine around the time of thyroid surgery helps. The pooled results reported lower pain scores at multiple time points (including 24 and 48 hours), better quality of recovery on postoperative days 1 and 2, and about half the risk of postoperative nausea and vomiting compared with placebo. The authors note variability across pain outcomes and advise caution interpreting clinical relevance; full methods and safety details need checking in the full paper.
Why it matters
- Addresses whether perioperative IV lidocaine reduces postoperative pain and PONV after thyroidectomy - outcomes that affect early recovery, length of stay, opioid requirements, and patient experience.
- If benefits are real and reproducible, IV lidocaine could be integrated into multimodal analgesia protocols for thyroid surgery, potentially reducing opioid use and improving quality of recovery (QoR).
- The paper pools 11 RCTs (943 patients) specifically in thyroidectomy, giving more directly relevant evidence than broader-surgery meta-analyses for this population.
Primary outcomes
- Postoperative pain scores at 1, 4, 8, 12, 24, and 48 hours
- Quality of recovery (QoR) scores postoperative day 1 and day 2
- Incidence of postoperative nausea and vomiting (PONV)
- Total postoperative opioid consumption
- Use of antiemetics
Effect summary
Abstract-reported pooled findings: IV lidocaine was associated with lower postoperative pain scores at 1, 4, 12, 24, and 48 hours (statistically significant at several time points; at 24 h SMD -0.52, 95% CI -1.01 to -0.03, I2 = 88.2%; at 48 h SMD -0.36, 95% CI -0.68 to -0.03, I2 = 34.1%). QoR improved on postoperative day 1 (MD 6.05, 95% CI 3.23 to 8.88) and day 2 (MD 6.52, 95% CI 4.97 to 8.06). IV lidocaine reduced PONV (RR 0.46, 95% CI 0.30 to 0.70). Rescue antiemetic use and duration of anaesthesia showed no significant difference per abstract. The authors caution that statistical significance and clinical relevance varied across pain outcomes.
Benefit-cost lens
| Quick take | Meta-analytic evidence suggests small-to-moderate improvements in pain scores, QoR, and reduced PONV with IV lidocaine in thyroidectomy; translating this into a favorable benefit-cost outcome requires absolute effect magnitudes, baseline risks, drug and delivery costs, and operational feasibility. |
|---|---|
| BCR anchor | 2 |
| Time horizon | 3 |
| Discount rate | 0.03 |
| Assumptions | Abstract-only triage used; full text needed to confirm dosing regimens, timing, adverse events, heterogeneity drivers, and study quality before any implementation or economic modelling. |
Benefit-cost fields are assumptions-based unless explicitly source-derived. Treat them as prompts for deeper economic review.
Risk of bias
| Tool | rapid-abstract-screen |
|---|---|
| Verdict | Some concerns |
| Notes | Assessment based only on abstract-level reporting. The meta-analysis pooled 11 RCTs, but high heterogeneity for some outcomes (e.g., 24 h pain I2=88.2%) and limited abstract detail on trial risk-of-bias domains (randomization methods, blinding, attrition, selective reporting, adverse event ascertainment). Full-text review required for a formal RoB 2 or GRADE assessment. |
Harms, equity, conflicts & implementation
| Implementation | Full-text review to extract dosing regimens and infusion protocols; staff training for perioperative IV lidocaine administration and monitoring; procurement of infusion supplies; local cost and workflow analysis; protocol for detecting and managing lidocaine toxicity. |
|---|---|
| Equity impact | Unclear from abstract. Equity effects depend on access to IV infusion capability, monitoring, and whether subgroups (age, comorbidities) have differential benefit or harm - full text required. |
| Harms | Abstract does not report detailed adverse event or toxicity data; safety conclusion in abstract is overall favourable but full-text review needed to assess arrhythmia, systemic toxicity, or other lidocaine-related harms and monitoring requirements. |
| Replication | Unknown from abstract-level triage; meta-regression and trial sequential analysis reported but replication of pooled estimates requires full-text data extraction. |
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