Intravenous lidocaine for gut function recovery in colonic surgery: a health economic evaluation of the ALLEGRO randomised clinical trial

Journal article

Objectives: To compare costs, health outcomes and cost-effectiveness of using intravenous lidocaine (bolus given at induction of anaesthesia, followed by infusion for 6–12 hours) during colorectal surgery to improve the return of gastrointestinal function. Design: Within-trial planned analysis of data from a randomised controlled trial using an intention-to-treat approach. Setting: 27 hospitals from across the UK. Participants: 557 patients aged 25–91 having minimally invasive elective colorectal resection. Intervention: A 1:1 randomisation between intravenous lidocaine and placebo, minimised for age (<50 years, 50–74 years, ≥75 years), gender, and trial centre. Primary outcome measures: Mean differences between trial arms in 30-day and 90-day quality-adjusted life-years (QALYs) and 30-day total National Health Service costs, as well as the 30-day incremental cost-effectiveness ratio. Results: Compliance and data quality were high. Intravenous lidocaine is associated with differences of £38 (95% CI: −£463, £589) in total 30-day costs, −0.0005 (95% CI: −0.0027, 0.0015) in 30-day QALYs and −0.0008 (95% CI: −0.0066, 0.0048) in 90-day QALYs. No large, statistically significant or meaningful differences in primary or secondary outcome measures between trial arms were detected, other than for the intervention costs. Conclusion: Intravenous lidocaine is not found to impact costs or health outcomes for patients undergoing colorectal surgery. In the absence of a clinical effect, disinvestment from perioperative lidocaine could save costs associated with infusion monitoring. Trial registration number: International Standard Randomised Controlled Trial Number 52352431.

Authors: Atter, M; Stoddart, A; Cotton, S; Vadiveloo, T; Innes, K

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: BMJ Publishing Group
• Journal: BMJ Open
• Volume: 15
• Issue: 2
• Article number: bmjopen-2024-088298
• Publication date: 2025-02-25
• Acceptance date: 2025-01-23
• DOI: 10.1136/bmjopen-2024-088298
• EISSN: 2044-6055
• Language: English
• Keywords: Economics; Endoscopy; Clinical Trial; Colorectal surgery