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    Study: Regional Anesthesia Better than General for Cancer Surgery Outcomes

    By Jennifer Huddleston, staff writer     

    A new study by Irish researchers revealed that regional anesthesia from a combination of propofol and a paravertebral block, rather than general anesthesia, can better preserve a patient’s immune defenses, thus reducing the development, extent and return of tumors. [1]

    “It has often been thought that our role as anesthetists has little impact on long-term cancer outcome, other than providing patient safety and comfort in the perioperative period,” said Catherine A. Deegan, M.B., lecturer in anesthesia at Mater Misericordiae University Hospital in Dublin, where the research was conducted. [2]

    Daniel Sessler, M.D., an anesthesiologist and chair of the outcomes research department at the Cleveland Clinic in Ohio, who has studied the topic but was not involved in the latest research, suggests that general anesthesia could weaken the body’s immune system and its ability to kill tumor cells released into the bloodstream during surgery, therefore making the cancer more likely to return. [3]

    Deegan’s study included 50 women undergoing surgery for primary breast cancer. Half of the group received regional anesthesia through propofol and a paravertebral block before general anesthesia was induced, and maintained with a target-controlled propofol mixture. The other half received balanced general anesthesia, induced with fentanyl and propofol. [4]

    To study the groups, researchers extracted blood samples from the patients before anesthesia induction and again 24 hours after the procedure and measured serum concentrations of 11 cytokines from before and after surgery. [5]  Cytokines, produced by cells, are proteins that are part of the body’s immune system response to disease or infection. [6]

    Researchers found significantly reduced levels of cytokines Interleukin (IL)-1 and IL-8, and significantly increased levels of IL-10 in patients who received propofol and a paravertebral block compared to the group that received standard doses of fentanyl and propofol. [7]

    According to Deegan, IL-10 has antitumor effects, while IL-1 indirectly advances tumor growth. While both groups saw a reduction in IL-1 levels, the decrease was significantly greater in the patients given regional anesthesia. [8]

    Regional anesthesia has been associated with a reduced stress response to surgery, in addition to a reduced need for opioids, Deegan said. [9]

    “There are a number of different factors that could be taken into account at the moment, the reduction of the stress response being one,” said Deegan. “We also saw significantly less pain and opioid consumption in the propofol-paravertebral group, and this may also play a role here.” [10]

    Because it is not known whether these findings will have any long-term effect on the patients’ cancer outcomes, Deegan will continue to follow the women over the next five years. [11]

    A similar study of patients undergoing surgery for breast cancer found that utilizing regional anesthesia in the form of propofol and a paravertebral block reduced the risk of recurrence or metastasis during the initial years of follow-up. [12]

    “Anesthesia was thought to be something that lasted a few hours and any consequences would be gone within a day,” said Sessler. “There is increasing evidence that this is not the case.”
    [13]


    [1] Vlessides, Michael. “Anesthesia Method During Tumor Surgery Tied to Cancer Outcomes.” Anesthesiology News , Volume 35:01. January 2009.
    [2]  Ibid.
    [3] Shekhar, Chandra. “Anesthesia: A Medical Mainstay Re-examined.” Los Angeles Times. May 14, 2007.
    [4] Vlessides, Michael. “Anesthesia Method During Tumor Surgery Tied to Cancer Outcomes.” Anesthesiology News , Volume 35:01. January 2009.
    [5]  Ibid.
    [6] Gale Encyclopedia of Medicine.
    [7] Vlessides, Michael. “Anesthesia Method During Tumor Surgery Tied to Cancer Outcomes.” Anesthesiology News , Volume 35:01. January 2009.
    [8]  Ibid.
    [9]  Ibid.
    [10]  Ibid.
    [11]  Ibid.
    [12] Exadaktylos, Aristomenis K., et al. “Can Anesthetic Technique for Primary Breast Cancer Surgery Affect Recurrence or Metastasis?” PubMed Central.
    [13] Shekhar, Chandra. “Anesthesia: A Medical Mainstay Re-examined.” Los Angeles Times. May 14, 2007. 


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