IV lidocaine does not expedite return of gut function 3 days after colon resection
Key takeaways:
- Return of gut function was similar between those administered lidocaine vs. placebo (57.3% vs. 59%).
- Lidocaine also did not have any impact on any of the 11 secondary endpoints.
Perioperative administration of 2% IV lidocaine had no significant effect on return of gut function at 72 hours among patients undergoing elective minimally invasive colonic resection, according to ALLEGRO trial results published in JAMA.
“There are currently no therapeutic interventions to accelerate return of gut function, prevent postoperative ileus or induce return of gut function after it occurs,” Hugh Paterson, MD, of the University of Edinburgh and Western General Hospital, and colleagues wrote. “Lidocaine has been used intravenously as an adjunct to general anesthesia during various types of surgery and has been found to reduce early postoperative pain scores and opioid requirements.”
They continued, “At the inception of the current trial, there was growing interest in use of perioperative IV lidocaine infusion in colorectal surgery for its perceived benefits on acute pain, opioid sparing and gut function return.”
In the ALLEGRO trial, Paterson and colleagues randomly assigned 590 adult patients undergoing minimally invasive colonic resection to 2% IV lidocaine or 0.9% saline placebo. For those receiving treatment, a 1.5 mg/kg bolus of lidocaine was administered at initiation of anesthesia, after which a 1.5 mg/kg per hour infusion was given for 6 or 12 hours.
Of those initially enrolled, 577 patients (mean age, 66 years; 44.7% women; lidocaine, n = 279; placebo, n = 278) were included in the primary analysis after postrandomization exclusions.
The primary outcome was return of gut function 72 hours following surgery, evaluated via the GI-3 composite of tolerating diet for 3 days in a row and passing gas or stool. In addition, the researchers assessed 11 secondary outcomes, including time to recovery, prolonged ileus, nausea and vomiting, opioid consumption, Quality of Recovery–15, quality of life, and time to meeting clinician criteria and patient self-assessed readiness for discharge.
According to researchers, return of gut function at 72 hours was observed in 57.3% of patients who received lidocaine vs. 59% with placebo, with an absolute difference of −1.9% (95% CI, −8% to 4.2%).
“Among adults undergoing elective minimally invasive colon resection, perioperative administration of 2% IV lidocaine infusion did not improve return of gut function at 72 hours,” Paterson and colleagues wrote.
In addition, treatment with lidocaine “showed no benefit” on any of the 11 secondary endpoints, they said.
The researchers reported that adverse events, the majority of which were mild or moderate and considered unrelated to treatment, were observed in 14.3% of those administered lidocaine and 13.3% of those receiving placebo. Further, they observed low mortality rates 30 and 90 days after surgery and similar lengths of hospital stay between groups (6 days vs. 5.8 days).
Unplanned readmission rates were also similar between those administered lidocaine vs. placebo (11.1% vs. 12.2%).
“Although this study reported no adverse events attributable to lidocaine using this administration schedule, there is ongoing concern that its use carries a risk of systemic toxicity and death,” the researchers wrote.
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