December's Paper of the Month aimed to evaluate the effect of 2% perioperative intravenous lidocaine infusion on return of gut function after elective minimally invasive colon resection.
Intravenous Lidocaine for Gut Function Recovery in Colonic Surgery. A Randomized Clinical Trial
Hugh Paterson, MD1,2; Thenmalar Vadiveloo, PhD3; Karen Innes, MSc4; Angie Balfour, MSc2,5; Marek Atter, MA5,6; Andrew Stoddart, MSc5,6; Seonaidh Cotton, PhD4; Robert Arnott, PhD7; Lorna Aucott, PhD3; Zoe Batham, MA4; Irwin Foo, MD2; Graeme MacLennan, MSc4; Susan Nimmo, MSc2; Doug Speake, MD2; John Norrie, MSc5,6
JAMA. doi:10.1001/jama.2024.23898
What is known about the subject?
Despite the recovery advantages of minimally invasive surgical techniques, delayed return of gut function after colectomy is a common barrier to timely discharge from hospital. The ALLEGRO trial aimed to establish if perioperative administration of 2% intravenous (IV) lidocaine affected postoperative return of gut function in adult patients undergoing elective minimally invasive colonic surgery.
What the study adds?
ALLEGRO was a randomised, placebo-controlled, double-blind trial conducted in 27 UK hospitals. A total of 590 adults were randomized 1:1 to 2% intravenous lidocaine or saline placebo.
The primary outcome was the proportion of patients with return of gut function at 72 hours after surgery, defined by the GI-3 composite end point of tolerating diet (ingestion of food and drink without significant nausea or vomiting for 3 consecutive meals) and passage of flatus or stool. Secondary outcomes included quality of recovery and quality of life.
The trial enrolled 590 patients (295 intervention, 295 control); following the exclusion of 33 patients post-randomization, the study sample comprised 557 patients (279 intervention, 278 control). Of these, 532 subjects (96%) received the allocated treatment. Return of gut function as defined by the GI-3 composite outcome was achieved at 72 hours by 160 patients (57.3%) in the intravenous lidocaine group vs 164 patients (59.0%) in the placebo group (adjusted absolute difference, −1.9% [95% CI, −8.0% to 4.2%]; relative risk, 0.97 [95% CI, 0.88 to 1.07]). There was no significant difference between the intervention and control groups in any of the secondary end points.
Implications for colorectal practice
ALLEGRO has shown that for patients undergoing elective minimally invasive colon resection, perioperative administration of 2% intravenous lidocaine did not improve return of gut function at 72 hours, the quality of recovery, or the quality of life.
