Does IV Lidocaine Help After Liver Surgery?
Intravenous lidocaine has become a common piece of opioid sparing anesthesia, but the liver is the organ that clears it, so liver surgery has always been a place where people hesitate to use it. A randomized, double blind trial published online in Anesthesiology in early November 2026 looked at exactly that question. In patients having minor liver surgery, a lidocaine infusion did not reduce opioid use over the first 24 hours. It did help a little early on, and it appeared safe.
The study
Östrand and colleagues at Lund University Hospital in Sweden randomized 124 patients planned for minor liver resection to lidocaine or saline placebo. The lidocaine group received a 1.5 mg/kg bolus followed by an infusion of 1.5 mg/kg/h that ran until one hour after surgery. Everyone had opioid patient controlled analgesia afterward. The primary outcome was opioid consumption during the first 24 hours. The team also tracked pain scores, quality of recovery, adverse events, length of stay, and plasma lidocaine levels.
Median 24 hour opioid use was 83 mg oral morphine equivalents with lidocaine and 97 mg with placebo, a difference that was not statistically significant (P = 0.429). Pain scores were lower with lidocaine at early time points but not from the first postoperative day on. Quality of recovery and adverse events were similar. Two patients briefly had plasma levels above 5 µg/ml after the bolus, with no signs of toxicity, and all levels measured after the resection and at the end of the infusion were well below the toxic range.
How I read it
This fits a pattern we have seen with lidocaine infusions for several years. Early trials and some meta-analyses suggested meaningful benefit, but larger and better blinded studies in many surgical groups have shown smaller effects than we hoped. Here the trend favored lidocaine by about 14 mg of oral morphine equivalents, which is modest even if it had reached significance. With 124 patients the trial could miss a small effect, but it argues against a large one.
The safety data may be the more useful part. Clinicians worry about giving a hepatically cleared drug to someone who is losing part of the liver during the case. These were minor resections in patients who were selected for surgery, so I would not stretch the findings to major hepatectomy or to patients with significant cirrhosis. The two transient peaks after the bolus are also a reminder that dosing on actual body weight and watching the total dose still matter.
What it means for practice here
For my own patients in Casper, I see lidocaine as one option among several rather than a must have. For minor liver surgery, this trial suggests it is reasonable to use if it fits the rest of the plan, but I would not expect it to change opioid needs much on its own. Good multimodal analgesia, regional techniques where they make sense, and attention to the basics are likely to matter more. It is also a good example of why we keep testing common practices in the specific populations where we use them.
Source
- Östrand E, Rystedt J, Östlund I, Kander T, Andersson B, Tingstedt B. Intravenous lidocaine in liver surgery: a randomized double-blind trial. Anesthesiology. Published online November 2026. doi:10.1097/ALN.0000000000006467. Article page
- Trial registration: NCT05153785
This post is clinician commentary for educational discussion. It is not medical advice for any reader's personal care. Anesthesia and perioperative decisions should be made with the treating clinician based on the individual patient's circumstances.