Efficacy and safety of intraperitoneal lidocaine in patients undergoing laparoscopic cholecystectomy: a systematic review and meta-analysis of randomized clinical trials.

BACKGROUND: Postoperative pain remains a significant clinical challenge following laparoscopic cholecystectomy (LC), with up to 80% of patients experiencing moderate to severe pain. Intraperitoneal (IP) lidocaine has emerged as a promising opioid-sparing analgesic technique, though evidence regarding its efficacy remains inconsistent. AIMS: To critically evaluate the analgesic efficacy and safety of intraperitoneal lidocaine compared with saline and intravenous lidocaine in patients undergoing laparoscopic cholecystectomy. METHODS: We included randomized controlled trials comparing IP lidocaine with saline or intravenous (IV) lidocaine in patients undergoing LC. We searched PubMed, Scopus, Web of Science, and Cochrane Library from inception to November 2025. Primary outcomes included early (0-8 h), late (24 h), and shoulder tip postoperative pain scores. Secondary outcomes comprised opioid consumption, hospital length of stay, and postoperative nausea and vomiting (PONV) incidence. Random-effects models were used for all analyses, with subgroup analyses based on lidocaine dosage. RESULTS: Eight randomized controlled trials involving 532 patients were included. Compared to saline, IP lidocaine significantly reduced early postoperative pain (MD = -1.06, 95% CI: -1.78 to -0.34, p = 0.004), late pain at 24 h (MD = -0.60, 95% CI: -1.00 to -0.21, p = 0.003), and shoulder tip pain (MD = -1.04, 95% CI: -1.82 to -0.26, p = 0.009). Total opioid consumption was significantly reduced (SMD = -3.68, 95% CI: -6.65 to -0.72, p = 0.01). No significant differences were observed in hospital length of stay or PONV incidence. When compared to IV lidocaine, IP administration showed no significant difference in early pain relief, but IV lidocaine demonstrated superior late pain control (MD = 1.99, 95% CI: 1.59 to 2.40, p < 0.00001) and longer time to first analgesic request (MD = -73.30 min, 95% CI: -98.65 to -47.95, p < 0.00001). CONCLUSION: IP lidocaine provides significant pain relief and reduces opioid consumption following LC compared to placebo. While it offers comparable early analgesic effects to IV lidocaine, systemic administration provides superior sustained pain relief. IP lidocaine represents a safe, cost-effective adjunct for multimodal analgesia in LC, particularly for addressing shoulder tip pain.