Expert consensus on perioperative intravenous lidocaine infusion in Chinese adult patients (2025 edition)

Lidocaine is a well-established amide local anaesthetic and antiarrhythmic agent. Its perioperative use as an intravenous infusion has expanded rapidly, with growing evidence supporting its benefits for postoperative analgesia and recovery. However, wider adoption remains limited by three issues: heterogeneous dosing and infusion protocols, inconsistent efficacy across clinical settings, and inadequate risk stratification for vulnerable patients. To promote the safe, standardized, and evidence-based use of intravenous lidocaine, the Youth Group of the Chinese Society of Anesthesiology and the Perioperative Medicine Professional Committee of the Chinese Medical Education Association convened a multidisciplinary expert panel. Following international guideline-development methodology, the panel developed this consensus based on the best available peer-reviewed evidence and expert clinical experience. The consensus provides 12 evidence-based recommendations concerning infusion regimens and clinical indications, including the prevention of propofol injection pain, attenuation of the hemodynamic stress response to tracheal intubation, management of acute postoperative pain, opioid sparing, prevention of postoperative nausea and vomiting and postoperative pulmonary complications, improvement of the quality of recovery, and sedation during colonoscopy. It also outlines absolute and relative contraindications and key principles for safety monitoring and adverse-event management. This consensus aims to provide practical guidance on the rational use of intravenous lidocaine in adults throughout the perioperative period, including during related invasive procedures. Practice guideline registration PREPARE-2025CN653.