IV lidocaine's pain benefit in spine surgery varies by procedure

A systematic review and meta-analysis of 10 randomized trials found that perioperative intravenous lidocaine infusion reduced postoperative pain at 24 hours and opioid consumption in adult spine surgery, with moderate-certainty evidence. A post hoc, exploratory subgroup analysis reported a clinically meaningful pain reduction after instrumented fusion or complex spine surgery but minimal benefit after decompression alone, a finding the authors describe as hypothesis-generating; no significant effects were seen on PONV or hospital length of stay.

Most relevant for: Adults undergoing spine surgery, particularly instrumented fusion or complex spine procedures, in perioperative pain management planning.

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