Block or Lidocaine Drip for Breast Cancer Surgery?
The erector spinae plane block has become a common part of anesthesia for breast cancer surgery. It is fairly easy to learn, it sits well away from the pleura and the neuraxis, and many of us believe it makes the first day after surgery more comfortable. But most breast patients today already get a solid multimodal pain plan. A trial published November 10, 2026 in Anesthesiology asked whether the block still adds anything on top of that, compared with a simple IV lidocaine infusion.
The study
Sivakumar and colleagues ran the trial at two centers, the Chinese University of Hong Kong and Sun Yat-sen University in Guangzhou. They randomized 80 adults having primary breast cancer surgery, with or without axillary dissection. One group received an ultrasound guided erector spinae plane block, and the other received an intraoperative IV lidocaine infusion. Placebo was used so that each patient got a sham version of the other treatment, and the trial was triple blinded. Everyone also got the same standardized multimodal analgesia. The main outcome was the QoR-15 quality of recovery score at 24 hours.
Both groups did very well. Mean QoR-15 at 24 hours was 137.7 with the block and 136.3 with lidocaine, a difference that was not significant, and both were close to the patients' scores before surgery. Pain scores, opioid use, and the need for rescue analgesia were low and similar in both groups. The authors reported no adverse events from either the block or the lidocaine.
How I read it
I think the main message is less about lidocaine and more about the baseline. When the multimodal plan is good, breast cancer surgery is often not very painful in the first 24 hours, and there is not much room left for any add on to show a benefit. That is useful to know. It is also a reminder that a block is a procedure with its own time, equipment, and small risks, and its value should be judged against what the patient would have had without it, not against nothing.
The trial has limits. Eighty patients is enough to rule out a large difference in recovery, but not a small one, and it cannot say much about rare complications. There was no group without either treatment, so we cannot tell whether either one beat the multimodal plan alone. It also looked at the first day. It does not tell us about chronic pain after mastectomy, which is a real problem for some women and a common reason people offer regional techniques. I also wrote recently about a liver surgery trial where IV lidocaine did not cut 24 hour opioid use, so I would not treat lidocaine as a sure thing either.
What it means for practice
For a smaller hospital, or on a day when no one experienced with blocks is free, this is reassuring. A lidocaine infusion within a strong multimodal plan appears to give a recovery close to what a block gives for this operation. It still needs proper dosing and attention to patients with heart rhythm problems or liver disease, and it is not risk free. In Casper, where I care for many patients having breast surgery, I see this as a reasonable option to offer, while the block remains a good choice when it can be done safely and on time. The bigger lesson for me is to get the basics of multimodal analgesia right first.
Source
- Sivakumar RK, Xiong W, Luckanachanthachote C, et al. Quality of recovery after primary breast cancer surgery: a randomized, two-centre, triple-blinded trial comparing erector spinae plane block and intravenous lidocaine infusion within a multimodal analgesia framework. Anesthesiology. Published online November 10, 2026. doi:10.1097/ALN.0000000000006476. Article · PubMed
This post is clinician commentary for educational discussion. It is not medical advice for any reader's personal care. Anesthesia and perioperative decisions should be made with the treating clinician based on the individual patient's circumstances.