Intravenous lidocaine eased pain after spinal fusion but did little after decompression

Design

Systematic review and meta-analysis of 10 randomised trials

Population

Adults undergoing spine surgery (655 in the primary analysis)

Primary outcome

Pain intensity at 24 hours

Effect

MD −0.83 (95% CI −1.36 to −0.30); fusion or complex −1.23 (−1.81 to −0.64); decompression −0.20 (−0.61 to 0.21)

A systematic review and meta-analysis in Regional Anesthesia & Pain Medicine (3 September 2026) pooled 10 randomised trials of perioperative intravenous lidocaine infusion against placebo or usual care in adult spine surgery.

Across nine trials and 655 patients, lidocaine reduced pain at 24 hours by 0.83 points on a 0 to 10 scale and cut opioid use by 11.6 mg of intravenous morphine equivalents. Heterogeneity was very high (I² 89%), and the prediction interval crossed zero. A post hoc analysis by procedure explained some of it: after instrumented fusion or complex surgery the reduction was 1.23 points, above the 1-point threshold that patients notice, whereas after decompression it was 0.20 points and not significant. Infusion rate made no difference. Nausea and length of stay did not change.

The procedure split is exploratory, and the authors say so. But it fits clinical sense: lidocaine adds most where pain is greatest. It supports using an infusion as part of multimodal analgesia for major spine surgery, and not spending effort on it for a simple decompression.

• Consider intravenous lidocaine infusion as part of multimodal analgesia for instrumented or complex spine surgery.
• Expect little benefit after simple decompression.
• Use your unit's standard weight-based protocol; higher infusion rates gave no extra benefit.
• Watch for signs of local anaesthetic toxicity, especially with other local anaesthetic blocks.
• Do not expect lidocaine to shorten stay or reduce nausea.

Why it matters

It targets an adjunct to the operations where it may help, instead of applying it to every spine case.

Don't overread it

The difference between procedures came from a post hoc subgroup analysis and is hypothesis-generating.

The statistics, in plain English

A mean reduction of 0.83 points is below the 1-point change patients usually notice. The prediction interval, from −2.69 to 1.02, means that in a new setting lidocaine could help a lot or not at all. High heterogeneity means the trials disagreed, and the procedure split explains part of why.

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