A 2,290-patient test of whether lidocaine earns its place in ERAS

Design

Single-centre, pragmatic, cluster-randomised, double-blind, placebo-controlled trial protocol

Population

2,290 patients across colorectal, emergency general, urological, hernia, surgical oncology and spine surgery

Primary outcome

Case-mix-adjusted length of stay and total inpatient opioid consumption over 72 hours

Effect

Not reported; the trial is in progress

Intravenous lidocaine has drifted into enhanced recovery pathways on the strength of small trials and a plausible mechanism — analgesic, anti-inflammatory, associated with faster return of gut function. What has never been established is what it contributes once the rest of a modern multimodal regimen is already in place, which is the only question that matters to a unit that already runs ERAS.

IMPALA-ERAS is a single-centre, pragmatic, cluster-randomised, double-blind, placebo-controlled trial enrolling 2,290 patients across elective colorectal surgery, emergency general surgery, urology, ventral hernia repair, surgical oncology and spine surgery. Patients receive intraoperative and postoperative lidocaine infusion for up to 48 hours, or placebo, inside an otherwise standardised multimodal regimen. The outcomes are pragmatic rather than physiological: case-mix-adjusted length of stay and total inpatient opioid consumption in the first 72 hours, in oral morphine milligram equivalents, with the remaining endpoints drawn from the electronic record.

Nothing changes today — there are no results. The reason to note it for a urological readership is the case mix: urology is one of the six enrolling services, so when this reports it will say something about your patients rather than requiring extrapolation from colorectal work. The design caveat worth carrying forward is that cluster randomisation at a single centre makes the result a strong statement about that hospital's pathway and a weaker one about yours.

• No change to your ERAS pathway on the basis of a protocol.
• If you already use lidocaine infusions, record the indication and duration so local outcomes are auditable.
• Note the primary outcomes are length of stay and opioid consumption, not pain scores.
• Watch for the urology subgroup when this reports, and for whether it was pre-specified.

Why it matters

It tests an agent that has already been adopted, against the regimen it was added to rather than against nothing.

Don't overread it

A protocol reports no outcomes and cannot support adding or removing lidocaine.

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