Intravenous Lidocaine Fails to Improve Gut Function Recovery After Colonic Surgery

A large, multi-center randomized clinical trial has found that intravenous lidocaine查看药品详情 does not improve the return of gut function in patients undergoing elective minimally invasive colonic surgery (搜索)搜索该疾病. The study, published in JAMA, challenges previous smaller trials and meta-analyses that suggested a potential benefit of lidocaine in accelerating postoperative recovery.

The ALLEGRO trial, conducted across 27 hospitals in the UK, involved 557 adult patients undergoing elective minimally invasive colon resection. Participants were randomized to receive either 2% intravenous lidocaine查看药品详情 or a saline placebo during the perioperative period. The primary outcome was the proportion of patients with return of gut function at 72 hours after surgery, defined by the GI-3 composite endpoint of tolerating diet and passage of flatus or stool.

The results showed no significant difference between the lidocaine查看药品详情 and placebo groups in the primary outcome. At 72 hours, 57.3% of patients in the lidocaine group and 59.0% in the placebo group had achieved return of gut function (adjusted absolute difference, -1.9% [95% CI, -8.0% to 4.2%]; relative risk, 0.97 [95% CI, 0.88 to 1.07]).

Secondary Outcomes

The study also assessed 11 secondary outcomes, including time to GI-3 recovery, time to GI-2 recovery, prolonged postoperative ileus (搜索)搜索该疾病, postoperative nausea and vomiting, opioid consumption, and quality of life. None of these secondary outcomes showed a significant difference between the lidocaine查看药品详情 and placebo groups.

Study Design and Patient Population

The ALLEGRO trial enrolled adults scheduled for elective minimally invasive colon resection for benign or malignant disease. Patients received either intravenous lidocaine查看药品详情 (1.5-mg/kg bolus followed by 1.5 mg/kg/h for 6 or 12 hours) or a saline placebo. The primary outcome was measured using the GI-3 composite endpoint, and secondary outcomes were assessed through patient questionnaires and hospital records.

Implications and Context

Delayed return of gut function after colectomy is a common barrier to timely hospital discharge, even with minimally invasive surgical techniques and enhanced recovery protocols. While lidocaine查看药品详情 has been investigated for its potential antinociceptive and anti-inflammatory properties, this large trial did not demonstrate any significant benefit in improving gut function recovery.

"The current trial also confirms that delayed return of gut function affects a substantial proportion of patients undergoing minimally invasive colonic resection," the authors noted.

Limitations

The authors acknowledged several limitations, including the exclusion of more complex colorectal operations and the lack of a strict protocol for anesthetic or surgical technique. Additionally, the study did not include information about participant race or ethnicity or socioeconomic status.

Conclusion

The ALLEGRO trial provides strong evidence that perioperative intravenous lidocaine查看药品详情 does not improve return of gut function after elective minimally invasive colonic surgery (搜索)搜索该疾病. These findings suggest that alternative strategies are needed to address the challenge of delayed gut function recovery in this patient population.