PERIOPERATIVE administration of 2% intravenous (IV) lidocaine does not significantly improve the return of gut function in adults undergoing elective minimally invasive colonic surgery, according to new research.
The ALLEGRO trial, which involved 557 patients across 27 UK hospitals from August 2018–April 2023, aimed to determine whether 2% IV lidocaine could speed up the return of gut function following colon resection surgery. This function, vital for recovery and timely hospital discharge, is often delayed after such procedures, creating a barrier to patients leaving the hospital.
In this randomised, double-blind study, patients were split into two groups: one received 2% IV lidocaine, and the other received a saline placebo. The intervention group received a 1.5 mg/kg bolus of lidocaine at the start of surgery, followed by an infusion of 1.5 mg/kg per hour for 6 to 12 hours. The primary outcome was whether patients resumed normal gut function, defined by tolerating food and drink without nausea or vomiting, and passing gas or stool, 72 hours after surgery.
The results showed no significant difference between the groups. At 72 hours, 57.3% of those in the IV lidocaine group had returned to normal gut function, compared to 59.0% in the placebo group. The adjusted absolute difference between the groups was a mere −1.9%, with a relative risk of 0.97, indicating no substantial benefit of lidocaine. Furthermore, there were no notable differences in any of the study’s secondary outcomes, including time to recovery, postoperative opioid use, or readiness for discharge.
This study concludes that, for adults undergoing minimally invasive colon resection, perioperative administration of 2% IV lidocaine does not provide any significant advantage in terms of the return of gut function at 72 hours post-surgery.
Ada Enesco, EMJ
Reference
Paterson H et al. Intravenous lidocaine for gut function recovery in colonic surgery: a randomized clinical trial. JAMA. 2024; DOI: 10.1001/jama.2024.23898.
