Intravenous lidocaine to prevent postoperative airway complications in adults: a systematic review and meta-analysis

Br J Anaesth. 2020 Mar;124(3):314-323. doi: 10.1016/j.bja.2019.11.033. Epub 2020 Jan 28.


Background: In surgical patients undergoing general anaesthesia, coughing at the time of extubation is common and can result in potentially dangerous complications. We performed a systematic review and meta-analysis to assess the efficacy and safety of i.v. lidocaine administration during the perioperative period to prevent cough and other airway complications.

Methods: We searched Medical Literature Analysis and Retrieval System, Excerpta Medica database, and Cochrane Central Register of Controlled Trials for RCTs comparing the perioperative use of i.v. lidocaine with a control group in adult patients undergoing surgery under general anaesthesia. The RCTs were assessed using risk-of-bias assessment, and the quality of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluations (GRADE).

Results: In 16 trials (n=1516), the administration of i.v. lidocaine compared with placebo or no treatment led to large reductions in post-extubation cough (risk ratio [RR]: 0.64; 95% confidence interval [CI]: 0.48-0.86) and in postoperative sore throat at 1 h (RR: 0.46; 95% CI: 0.32-0.67). There was no difference in incidence of laryngospasm (risk difference [RD]: 0.02; 95% CI: -0.07 to 0.03) or incidence of adverse events related to the use of lidocaine.

Conclusions: The use of i.v. lidocaine perioperatively decreased airway complications, including coughing and sore throat. There was no associated increased risk of harm.

Keywords: airway; anaesthesia; complication; cough; lidocaine; pharyngitis; postoperative outcomes; tracheal tube.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Anesthesia, General / adverse effects*
  • Anesthetics, Local / administration & dosage*
  • Anesthetics, Local / therapeutic use
  • Cough / etiology
  • Cough / prevention & control*
  • Device Removal / adverse effects
  • Humans
  • Injections, Intravenous
  • Intubation, Intratracheal / adverse effects
  • Lidocaine / administration & dosage*
  • Lidocaine / therapeutic use
  • Perioperative Care / methods
  • Pharyngitis / etiology
  • Pharyngitis / prevention & control
  • Postoperative Complications / prevention & control*


  • Anesthetics, Local
  • Lidocaine