Prevention of persistent pain with lidocaine infusions in breast cancer surgery (PLAN): study protocol for a multicenter randomized controlled trial
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 ,   PLAN Trial Investigators, Parvez Elena , Hong Nicole J. Look , Wright Frances C. , Roberts Amanda , Escallon Jaime , Ko Gary , Huang Alexander , Zasso Fabricio B. , Leong Wey L. , Covelli Andrea M. , Meng Howard , Sjaus Ana , Kerelska Tina , Uppal Vishal , Gleicher Yehoshua , O’Neill Anne , Wang Li , Sellers Daniel , Chuquer Maria B. C. , Hawboldt Geoffrey S. , Hofer Stefan O. P. , Shanthanna Harsha , Helyer Lucy K. , Ansari Bilal M. , Ladak Salima S. J. , Oyberman Inna , Cordeiro Erin , Moreno Carlos A. Ibarra , Dana Elad , Busse Jason W. , Buckley D Norman , Haykal Siba , McCluskey Stuart A. , McKeen Dolores , Wiegelmann Julian , Warden Geoffrey , Sparrow Kathryn A. , Singh Mandeep , Bosma Rachael , Flamer David , Mah Richard L. , Diliane Derek , Bouchard-Fortier Antoine , Laws Alison , Drohan Ashley 
Published: May 2024

Abstract
Background
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.

Methods
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.

Discussion
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.

Trial registration
This trial has been registered on clinicaltrials.gov (NCT04874038, Dr. James Khan. Date of registration: May 5, 2021).