Intravenous Lidocaine Ineffective for Gut Function Recovery After Colon Surgery, finds research

While this study reported no adverse events linked to the lidocaine administration schedule used, concerns remain about the potential risks of systemic toxicity and fatal outcomes associated with its use.

Despite the recovery benefits associated with minimally invasive surgical techniques, delayed return of gut function following colectomy remains a frequent obstacle to timely hospital discharge. Considering this challenge, Hugh Paterson, University of Edinburgh, Edinburgh, United Kingdom, and colleagues set out to assess the impact of a 2% perioperative intravenous lidocaine infusion on gut function recovery after elective minimally invasive colon resection.

For this purpose, the researchers conducted the ALLEGRO trial, a randomized, placebo-controlled, double-blind study in 27 UK hospitals. Between August 2018 and April 2023, 590 adults undergoing elective minimally invasive colon resection for benign or malignant conditions were randomized to receive 2% intravenous lidocaine or saline placebo. Lidocaine was administered as a 1.5-mg/kg bolus followed by a 1.5 mg/kg/h infusion for 6 or 12 hours, while the placebo group received saline.

The primary outcome was gut function recovery at 72 hours post-surgery, with 11 secondary outcomes, including postoperative ileus, recovery timelines, opioid use, and quality of life measures.

The following were the key findings of the study:

• A total of 590 patients were enrolled, 295 were randomized to the intervention group and 295 to the control group.
• After 33 postrandomization exclusions, 557 patients were included in the analysis (279 intervention, 278 control).
• The study population included 249 female patients (44.7%), with a mean age of 66.
• Of the participants, 96% received the randomized treatment.
• Return of gut function at 72 hours, defined by the GI-3 composite outcome, was achieved by 57.3% of patients in the lidocaine group and 59.0% in the placebo group.
• The adjusted absolute difference in gut function recovery between groups was −1.9%.
• No significant differences were observed between the intervention and control groups for the 11 secondary endpoints.

This study had limitations, including no data on race, ethnicity, or socioeconomic status, exclusion of complex colorectal surgeries, and lack of strict protocols for anesthetic or surgical techniques. Additionally, subgroup analysis showed no difference between 6-hour and 12-hour lidocaine infusions, making longer durations unlikely to improve outcomes and riskier.

"The findings showed that in adults undergoing elective minimally invasive colon resection, perioperative infusion of 2% IV lidocaine showed no improvement in gut function recovery at 72 hours," the researchers concluded.

Reference:

Paterson H, Vadiveloo T, Innes K, et al. Intravenous Lidocaine for Gut Function Recovery in Colonic Surgery: A Randomized Clinical Trial. JAMA. Published online November 27, 2024. doi:10.1001/jama.2024.23898