Effects of perioperative intravenous lidocaine on postoperative recovery quality in thoracoscopic surgery: a systematic review and meta-analysis

Thoracoscopic surgery, while minimally invasive, is associated with significant postoperative pain, nausea and vomiting, and hemodynamic instability, which can impede recovery. Intravenous lidocaine has been proposed as a multimodal analgesic adjunct due to its potential anti-inflammatory and analgesic properties. This meta-analysis aims to evaluate the effects of perioperative intravenous lidocaine on recovery outcomes in patients undergoing thoracoscopic surgery. Following PRISMA guidelines, a systematic search was conducted in seven databases (CNKI, Wanfang, VIP, CBM, PubMed, Embase, Cochrane Library) from their inception to August 2025 for randomized controlled trials (RCTs) comparing intravenous lidocaine versus saline placebo in thoracoscopic surgery. Primary outcomes were postoperative pain scores (VAS/NRS) and incidence of postoperative nausea and vomiting (PONV). Secondary outcomes included postoperative pulmonary complications (PPC), intraoperative fentanyl consumption, postoperative opioid consumption, hemodynamic parameters (MAP, HR), and Quality of Recovery-40 (QoR-40) scores. Meta-analysis was performed using Review Manager 5.4. The study protocol was registered in PROSPERO (ID: CRD420251183680). Fifteen RCTs involving 1103 patients were included. Lidocaine significantly reduced pain scores at all time points (0–48 h), with peak effect at 2 h (MD = -1.68, P < 0.00001). PONV incidence was lower in the lidocaine group (OR: 0.42, P < 0.00001). Although not statistically significant, a trend toward reduced postoperative pulmonary complications was observed (OR: 0.82, P = 0.26). Intraoperative fentanyl consumption (MD: -92.10, P < 0.00001) and postoperative opioid use (MD: -0.64, P = 0.03) were significantly lower in the lidocaine group. Lidocaine also attenuated hemodynamic responses during intubation and extubation (MAP and HR, P < 0.00001) and improved QoR-40 scores (MD: 2.98, P = 0.003). Regarding safety, reported adverse events were minor and transient, but current evidence is insufficient to fully characterize the safety profile due to inconsistent monitoring and reporting across trials. Perioperative intravenous lidocaine enhances recovery after thoracoscopic surgery by improving analgesia, reducing PONV and opioid use, stabilizing hemodynamics, and promoting overall recovery quality. It should be considered within multimodal ERAS protocols. Further standardized RCTs are warranted to optimize dosing and assess long-term benefits.