Impact of PerioperAtive LidocAine Infusions on Enhanced Recovery After Noncardiac Surgery (IMPALA-ERAS) in an inpatient setting: rationale, design and protocol for a sequential, repeated crossover trial.

TL;DR

The IMPALA-ERAS trial is a pragmatic, cluster-randomized, double-blinded, placebo-controlled study examining whether perioperative intravenous lidocaine infusions (up to 48 hours) integrated into established ERAS pathways improve postoperative recovery and reduce opioid consumption in 2,290 patients undergoing various elective and emergency surgeries.

Key findings

• Primary outcomes are resource-adjusted length of stay and total inpatient opioid consumption within 72 hours
• Lidocaine is evaluated for its analgesic, anti-inflammatory, and gastrointestinal recovery properties as part of multimodal analgesia
• Study includes major surgical specialties: colorectal, general, urology, hernia, oncology, and spine surgery
• Protocol-driven approach with secondary outcomes extracted from electronic health records to assess in-hospital clinical endpoints

Why this matters at the bedside

Directly addresses optimization of perioperative analgesia within ERAS frameworks, which are now standard in many surgical programs. Findings could inform evidence-based decisions about lidocaine incorporation into multimodal analgesic regimens and opioid-sparing strategies.