Toner AJ, Bailey MA, Schug SA, et al. - The development of chronic postoperative pain after breast cancer surgery may be averted via perioperative lidocaine infusion. However, a large‐scale trial is needed to test this hypothesis. In order to determine the safety, effectiveness and feasibility of a pragmatic, multicentre trial design that is consistent with expert guidance, addresses the limitations of previous studies, and overcomes existing translational barriers, researchers here performed a double‐blind, randomized controlled pilot study including 150 patients undergoing breast cancer surgery across three hospitals in Western Australia. With novel safety monitoring tools in place, patients were administered lidocaine, or equivalent volumes of saline, as an intravenous bolus (1.5 mg.kg ^‐1 ) and infusion (2 mg.kg ^‐1.h‐1 ) intra‐operatively, and a subcutaneous infusion (1.33 mg.kg ^‐1 .h ^‐1 ) postoperatively for up to 12 h on a standard surgical ward. Patients in the placebo and lidocaine arms experienced in‐hospital safety events rarely, and similarly. Relative to previous trials describing improved pain outcomes, they observed comparable median serum lidocaine levels during intravenous and subcutaneous infusion. Overall observations support that in patients undergoing breast cancer surgery, this trial design is safe, effective and feasible, and a larger‐scale trial is planned.