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Perioperative Anesthesia Care and Tumor Progression

Sekandarzad, Mir W. FANZCA, FFPMANZCA, DESA*; van Zundert, André A.J. MD, PhD, FRCA, EDRA, FANZCA*; Lirk, Philipp B. MD, PhD; Doornebal, Chris W. MD; Hollmann, Markus W. MD, PhD, DEAA

doi: 10.1213/ANE.0000000000001652
Pain and Analgesic Mechanisms: Narrative Review Article
Continuing Medical Education

This narrative review discusses the most recent up-to-date findings focused on the currently available “best clinical practice” regarding perioperative anesthesia care bundle factors and their effect on tumor progression. The main objective is to critically appraise the current literature on local anesthetics, regional outcome studies, opioids, and nonsteroidal anti-inflammatory drugs (NSAIDs) and their ability to decrease recurrence in patients undergoing cancer surgery. A brief discussion of additional topical perioperative factors relevant to the anesthesiologist including volatile and intravenous anesthetics, perioperative stress and anxiety, nutrition, and immune stimulation is included. The results of several recently published systematic reviews looking at the association between cancer recurrences and regional anesthesia have yielded inconclusive data and provide insufficient evidence regarding a definitive benefit of regional anesthesia. Basic science data suggests an anti tumor effect induced by local anesthetics. New refined animal models show that opioids can safely be used for perioperative pain management. Preliminary evidence suggests that NSAIDs should be an essential part of multimodal analgesia. Volatile anesthetics have been shown to increase tumor formation, whereas preclinical and emerging clinical data from propofol indicate tumor protective qualities. The perioperative period in the cancer patient represents a unique environment where surgically mediated stress response leads to immune suppression. Regional anesthesia techniques when indicated in combination with multimodal analgesia that include NSAIDs, opioids, and local anesthetics to prevent the pathophysiologic effects of pain and neuroendocrine stress response should be viewed as an essential part of balanced anesthesia.

Published ahead of print November 8, 2016.

From the *Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women’s Hospital, The University of Queensland, Herston-Brisbane, Queensland, Australia; and Division of Anesthesiology, Intensive Care, Emergency Medicine, Pain Therapy and Palliative Care, University Medical Center Amsterdam, Amsterdam, the Netherlands.

Published ahead of print November 8, 2016.

Accepted for publication August 17, 2016.

Funding: None.

Conflicts of Interest: See Disclosures at the end of the article.

Reprints will not be available from the authors.

Address correspondence to André A.J. van Zundert, MD, PhD, FRCA, EDRA, FANZCA, Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women’s Hospital, The University of Queensland, Butterfield St, Herston-Brisbane, Queensland, Australia. Address e-mail to

© 2017 International Anesthesia Research Society
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