What a Pain: The Use of Intravenous Lidocaine Infusions to Improve Postoperative Pain in Adults Undergoing Colorectal Surgery

BACKGROUND: Veterans face significant health disparities such as delayed care, limited access, and higher rates of chronic pain and opioid prescriptions, which all contribute to increased addiction risks and healthcare costs. Intravenous lidocaine has been shown to reduce intraoperative opioid use and improve outcomes under Enhanced Recovery After Surgery (ERAS) protocols. Implementing a computer-based algorithm (CBA) is linked to improved compliance with ERAS protocols.

LOCAL PROBLEM: The project site has seen an increase in postoperative pain among patients, resulting in more frequent requests for pain management consultations and longer hospital stays. The issue has been linked to decreased compliance with ERAS protocols, specifically the use of intravenous lidocaine infusions. The purpose of the project was to increase compliance with lidocaine infusions by 25% for adults undergoing colorectal surgery. Project participants were veterans undergoing colorectal surgery.

METHODS: The Evidence-Based Practice Improvement (EBPI) model guided this project’s development, implementation, and evaluation. Colorectal cases were defined as open or laparoscopic cases that involved resection and/or anastomosis of the colon. Pre- and post-implementation data measured pain scores, PACU length of stay, and process compliance.

INTERVENTIONS: A CBA was introduced to prompt providers to initiate lidocaine infusions on appropriate patients. Education was provided to anesthesia and post-anesthesia care unit (PACU) staff to explain the purpose and use of the protocol.

RESULTS: Following implementation, compliance with intravenous lidocaine infusions reached 100%. Pre- and post-implementation data analysis revealed a clinical reduction in PACU pain by 3.7% and a statistically significant reduction in PACU length of stay of 46.5% (p < 0.05), meeting our aim.

CONCLUSIONS: The findings demonstrate that incorporating intravenous lidocaine as part of a standardized ERAS CBA enhances postoperative recovery and pain control. Sustainability plans include integrating ERAS and lidocaine education into new hire orientation, providing ongoing staff training, and maintaining active stakeholder involvement through regular multidisciplinary committee meetings.