Effects of Perioperative Lidocaine Infusion on Pain Management and Quality of Recovery Following Thyroid Surgery: A Systematic Review and Meta-analysis

Background Thyroid surgery is often considered minor, and the postoperative pain is usually ignored. However, according to previous researches, the pain after thyroid surgery ranged from moderate to severe. Poorly controlled pain may lead to a series of adverse events, including dissatisfaction of patients, bad recovery, and extended hospital stay. Intravenous infusion of lidocaine has been proven to be effective in relieving pain after cholecystectomy, spinal surgery, and colorectal surgery. This meta-analysis was designed to explore the effects of lidocaine infusion on pain management and quality of recovery after thyroid surgery. Methods We conducted a comprehensive search of the Cochrane Library, PUBMED, Web of Science, EMBASE, China National Knowledge Infrastructure (CNKI), Wanfang, VIP, and China Biomedical Literature Database (CBM) from inception to September 12, 2022. Based on our previously established inclusion and exclusion criteria, eligible studies were involved. The primary outcomes were postsurgical pain scores and quality of recovery. The secondary outcomes included opioids consumption, hemodynamics variables, time to awareness and extubation, and adverse events. All analyses were performed using the random effects model with RevMan 5.4 software. We also evaluated the evidence quality of results by GRADEprofiler 3.6. Results A sum of 11 RCTs with 761 patients were involved. Compared to the controlled group, lidocaine reduced pain scores at 2h, 4h, 8h, and 12h after surgery, but not at 24h and 48h. Besides, lidocaine also facilitated recovery (mean difference [MD] = 7, 95% CI [4.78–9.25], P = 0.40, I2 = 0%), reduced opioids consumption during surgery (MD=-5.61, 95% CI [-7.90, -3.31], P = 0.97, I2 = 0%), and lowered the incidence of cough during extubation (RR = 0.41, 95% CI [0.30, 0.56], P = 0.34, I2 = 10%). No lidocaine-related adverse events was found in our meta-analysis. Conclusions Perioperative infusions of lidocaine could alleviate postoperative pain and facilitate recovery on the first day after surgery, without causing adverse events. Considering the high heterogeneity and relatively low quality of evidence among most of the results, further validation is reasonable.