Intravenous lidocaine infusion accelerates postoperative bowel function recovery in patients undergoing lumbar surgery: a multi-center, randomized controlled trial

BACKGROUND: Lumbar surgery is often associated with significant postoperative pain, high opioid consumption, and delayed bowel function recovery. This study aimed to assess whether intravenous lidocaine infusion could enhance bowel function recovery in patients undergoing lumbar surgery. METHOD: This multicenter, randomized, controlled, double-blinded study was conducted across three tertiary university hospitals. A total of 96 patients, aged 60-80 years, with an American Society of Anesthesiologists (ASA) classification of I-III, scheduled for lumbar spinal surgery, were randomly assigned to either the lidocaine group (L group) or the control group (C group) in a 1:1 ratio. Patients in the L group received perioperative intravenous lidocaine infusion and, postoperatively, lidocaine as a component of the multimodal patient-controlled analgesia regimen, whereas patients in the C group received normal saline in place of lidocaine under the same regimen. The primary outcome was the time to first evacuation. Secondary outcomes included the time to first defecation, intraoperative opioid consumption, incidence of postoperative nausea and vomiting (PONV), numerical rating scale (NRS) pain scores at rest and during movement, postoperative opioid consumption, and length of hospital stay. RESULTS: Patients in the L group had a significantly shorter evacuation time compared to the C group [(17 hours; 95% CI, 14-20 hours) vs (23 hours; 95% CI, 19-28 hours); P = 0.013)]. Intraoperative opioid consumption was significantly lower in the L group than in the C group, including sufentanil (18 [15, 20] µg vs. 25 [17, 30] µg, P < 0.001) and remifentanil (760 [450, 1040] µg vs. 1000 [760, 1440] µg, P = 0.002). Additionally, propofol usage was significantly lower in the L group compared to the C group (591.57 ± 206.39 mg vs. 692.96 ± 229.50 mg, P = 0.027). No significant differences were observed between the groups for other secondary outcomes. CONCLUSIONS: Intravenous lidocaine infusion in patients undergoing lumbar surgery accelerates postoperative bowel function recovery and reduces intraoperative opioid consumption.