Lidocaine Infusion for Reducing Postoperative Ileus after Colorectal Surgery

Abstract

Introduction: Postoperative ileus delays recovery after colorectal surgery. This review examines whether systemic lidocaine infusion reduces ileus duration through anti-inflammatory and prokinetic mechanisms.

Methods: Literature review of randomized placebo-controlled trials of intravenous lidocaine infusion (bolus 1-2 mg/kg followed by 1-3 mg/min intraoperatively and up to 24 hours postoperatively) in adults undergoing elective colorectal resection. Primary outcome was time to first flatus. Secondary outcomes included time to tolerating solid food and hospital length of stay.

Results: Thirteen trials (1,324 patients) were analyzed. Lidocaine reduced time to first flatus by a mean of 9 hours and time to solid food tolerance by 11 hours compared to placebo. Hospital stay was shorter by 1.3 days. Pain scores and opioid consumption were also reduced. No lidocaine toxicity symptoms (perioral numbness, tinnitus, seizures) were reported.

Discussion: Lidocaine suppresses neutrophil activation, reduces endothelin release, and enhances gastrointestinal motility via enteric nerve modulation. The lack of toxicity in these trials likely reflects adherence to safe dosing guidelines and exclusion of patients with severe hepatic disease. Most trials used open-label designs, introducing potential bias.

Conclusions: Perioperative intravenous lidocaine infusion is effective for reducing postoperative ileus and shortening hospitalization after colorectal surgery. Doses within recommended safety limits appear well tolerated.