Prevention of persistent pain with lidocaine infusions in breast cancer surgery (PLAN): study protocol for a multicenter randomized controlled trial

• Published in: Current controlled trials in cardiovascular medicine Vol. 25; no. 1; p. 337
• Main Authors: Khan, James S, Gilron, Ian, Devereaux, P J, Clarke, Hance, Ayach, Nour, Tomlinson, George, Quan, May Lynn, Ladha, Karim S, Choi, Stephen, Munro, Allana, Brull, Richard, Lim, David W, Avramescu, Sinziana, Richebé, Philippe, Hodgson, Nicole, Paul, James, McIsaac, Daniel I, Derzi, Simone, Zbitnew, Geoff L, Easson, Alexandra M, Siddiqui, Naveed T, Miles, Sarah J, Karkouti, Keyvan
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 22-05-2024; BioMed Central; BMC
• Subjects: Analgesics, Opioid - administration & dosage; Analgesics, Opioid - adverse effects; Analgesics, Opioid - therapeutic use; Anesthetics, Local - administration & dosage; Anesthetics, Local - adverse effects; Breast cancer; Breast cancer surgery; Breast Neoplasms - surgery; Cancer; Cancer surgery; Care and treatment; Chronic pain; Chronic Pain - etiology; Chronic Pain - prevention & control; Chronic postsurgical pain; Clinical trials; Cost-Benefit Analysis; Diabetic neuropathy; Female; Gastrointestinal surgery; Humans; Infusions, Intravenous; Lidocaine - administration & dosage; Lidocaine - adverse effects; Lidocaine infusion; Lumpectomy; Mastectomy; Mastectomy - adverse effects; Mastectomy, Segmental - adverse effects; Medical prognosis; Medical screening; Multicenter Studies as Topic; Narcotics; Nervous system; Oncology, Experimental; Pain; Pain Measurement; Pain, Postoperative - diagnosis; Pain, Postoperative - etiology; Pain, Postoperative - prevention & control; Perioperative care; Post-mastectomy pain syndrome; Prevention; Quality of Life; Questionnaires; Randomized Controlled Trials as Topic; Study Protocol; Systematic review; Time Factors; Treatment Outcome; Canada; Breast cancer surgery; Chronic postsurgical pain; Perioperative care; Lidocaine infusion; Chronic pain; Post-mastectomy pain syndrome
• ISSN: 1745-6215; 1745-6215
• DOI: 10.1186/s13063-024-08151-4

Persistent pain is a common yet debilitating complication after breast cancer surgery. Given the pervasive effects of this pain disorder on the patient and healthcare system, post-mastectomy pain syndrome (PMPS) is becoming a larger population health problem, especially as the prognosis and survivorship of breast cancer increases. Interventions that prevent persistent pain after breast surgery are needed to improve the quality of life of breast cancer survivors. An intraoperative intravenous lidocaine infusion has emerged as a potential intervention to decrease the incidence of PMPS. We aim to determine the definitive effects of this intervention in patients undergoing breast cancer surgery.
PLAN will be a multicenter, parallel-group, blinded, 1:1 randomized, placebo-controlled trial of 1,602 patients undergoing breast cancer surgery. Adult patients scheduled for a lumpectomy or mastectomy will be randomized to receive an intravenous 2% lidocaine bolus of 1.5 mg/kg with induction of anesthesia, followed by a 2.0 mg/kg/h infusion until the end of surgery, or placebo solution (normal saline) at the same volume. The primary outcome will be the incidence of persistent pain at 3 months. Secondary outcomes include the incidence of pain and opioid consumption at 1 h, 1-3 days, and 12 months after surgery, as well as emotional, physical, and functional parameters, and cost-effectiveness.
This trial aims to provide definitive evidence on an intervention that could potentially prevent persistent pain after breast cancer surgery. If this trial is successful, lidocaine infusion would be integrated as standard of care in breast cancer management. This inexpensive, widely available, and easily administered intervention has the potential to reduce pain and suffering in an already afflicted patient population, decrease the substantial costs of chronic pain management, potentially decrease opioid use, and improve the quality of life in patients.
This trial has been registered on clinicaltrials.gov (NCT04874038, Dr. James Khan. Date of registration: May 5, 2021).