Evaluation of lidocaine as a dual-route prophylaxis in postoperative catheter-related bladder discomfort: a comprehensive systematic review and meta-analysis with trial sequential analysis and GRADE evaluation

Catheter-related bladder discomfort (CRBD) is a common postoperative problem following urinary catheterization. Current pharmacologic options have limited use due to side effects. Lidocaine, with analgesic, anti-inflammatory, and antimuscarinic properties, may provide an effective and safer alternative. This study aims to systematically evaluate (1) the efficacy of intravenous (IV) lidocaine compared with normal saline, (2) the efficacy of intravesical lidocaine compared with normal saline, and (3) postoperative outcomes including opioid requirements, as specified in the PROSPERO registration (CRD420251155678). A systematic search of randomized controlled trials (RCTs) was conducted in accordance with PRISMA guidelines. Studies comparing intravenous or intravesical lidocaine with normal saline for CRBD prevention in adult surgical patients were included. Primary outcomes were CRBD incidence and severity at predefined postoperative time points. Secondary outcomes included opioid consumption when reported. Study quality was assessed using the RoB 2 tool, and the certainty of evidence was evaluated by GRADE and trial sequential analysis (TSA). Five RCTs, including 463 patients, were analyzed. Lidocaine significantly reduced moderate-to-severe CRBD compared with saline at 0 h (RR = 0.42, 95% CI 0.32-0.55), 1 h (RR 0.42, 95% CI 0.28, 0.61), and 2 h (RR 0.33, 95% CI 0.12, 0.90), but not at 6 h (RR 0.30, 95% CI 0.07, 1.22). No significant difference was observed in postoperative opioid consumption (MD - 0.56, 95% CI - 1.14, 0.03). TSA confirmed conclusive results at 0 and 1 h, with high-certainty evidence per GRADE. Both IV and transurethral lidocaine significantly reduce early postoperative CRBD. Lidocaine represents a safe, effective, and easily applicable option for short-term prevention of CRBD.