• cancer/tumors
• statistics
• surgical repair
• treatment

• Humans
• Retrospective Studies
• Osteosarcoma/surgery
• Sarcoma/surgery
• Anesthesia, Conduction/methods
• Bone Neoplasms

• TL1 TR002555 NCATS NIH HHS
• TL1 TR002555 NCATS NIH HHS

• Critical care
• Muscle weakness
• Neoplasms
• Respiratory function tests
• Respiratory mechanics
• Surgical Oncology

• Cellular immunity
• cytokinesis
• epidural block
• esophageal cancer
• long-term follow-up
• paravertebral block

Background: In patients with prostatic and breast cancer the application of peridural anesthesia (PDA) showed a beneficial effect on prognosis. This was explained by reduced requirements for general anesthetics and perioperative opioids as well as a lower perioperative stress level. The impact of PDA in patients with more aggressive types of cancer has not been completely elucidated. Here, we analyzed the prognostic influence of PDA on overall survival after surgery as primary in patients that underwent radical resection of pancreatic adenocarcinoma. Methods: Records of 98 consecutive patients were reviewed. In 70 of these cases PDA was applied. Patient characteristics such as demographics, TNM stage, and operative data were retrospectively collected from medical records and analyzed. Survival data were analyzed by Cox’s proportional hazard regression model. Results: Overall, no significant prognostic influence of PDA on recurrence or overall survival (p = 0.762, Hazard Ratio [HR] 0.884, 95% confidence interval [CI] 0.398–1.961) was found. However, there was a trend towards a longer overall survival (p = 0.069, HR 0.394, 95% CI 0.144–1.078) associated with PDA in a subgroup of patients with better differentiation of pancreatic adenocarcinoma. Conclusion: The observation of longer survival associated with PDA in our subgroup of patients with better-differentiated pancreatic carcinomas is in line with previous reports on various other less aggressive tumor entities. Our results indicate that PDA might improve the oncological outcome of patients with pancreatic adenocarcinoma.

• oncological outcome
• pancreatic adenocarcinoma
• recurrence
• staging

• cancer
• colon cancer
• nerve blocks
• regional anesthesia

The question of whether anesthetic, analgesic or other perioperative intervention during cancer resection surgery might influence long-term oncologic outcomes has generated much attention over the past 13 years. A wealth of experimental and observational clinical data have been published, but the results of prospective, randomized clinical trials are awaited. The European Union supports a pan-European network of researchers, clinicians and industry partners engaged in this question (COST Action 15204: Euro-Periscope). In this narrative review, members of the Euro-Periscope network briefly summarize the current state of evidence pertaining to the potential effects of the most commonly deployed anesthetic and analgesic techniques and other non-surgical interventions during cancer resection surgery on tumor recurrence or metastasis.

• analgesia
• anesthesia
• cancer

• glioblastoma
• isoflurane
• proliferation and invasion
• stem cells

To prospectively evaluate the effect of local wound infiltration with ropivacaine on postoperative pain relief and stress response reduction after open hepatectomy.

A total of 56 patients undergoing open hepatectomy were randomly divided into two groups: a ropivacaine group (wound infiltration with ropivacaine solution) and a control group (infiltration with isotonic saline solution). A visual analog scale (VAS) at rest and on movement was used to measure postoperative pain for the first 48 h after surgery. Mean arterial pressure (MAP), heart rate (HR), time to bowel recovery, length of hospitalization after surgery, cumulative sufentanil consumption, and incidence of nausea and vomiting were compared between the two groups. Surgical stress hormones (epinephrine, norepinephrine, and cortisol) were detected using enzyme-linked immunosorbent assay, and the results were compared.

VAS scores both at rest and on movement at 24 h and 48 h were similar between the two groups. Significantly lower VAS scores were detected at 0, 6, and 12 h in the ropivacaine group compared with the control group (P < 0.05 for all). MAP was significantly lower at 6, 12, and 24 h (P < 0.05 for all); HR was significantly lower at 0, 6, 12, and 24 h (P < 0.05 for all); time to bowel recovery and length of hospitalization after surgery (P < 0.05 for both) were significantly shortened; and cumulative sufentanil consumption was significantly lower at 6, 12, 24, and 36 h (P < 0.05 for all) in the ropivacaine group than in the control group, although the incidence of nausea and vomiting showed no significant difference between the two groups. The levels of epinephrine, norepinephrine, and cortisol were significantly lower in the ropivacaine group than in the control group at 24 and 48 h (P < 0.01 for all).

Local wound infiltration with ropivacaine after open hepatectomy can improve postoperative pain relief, reduce surgical stress response, and accelerate postoperative recovery.

• Local wound infiltration
• Ropivacaine
• Open hepatectomy
• Postoperative pain
• Surgical stress

• Adult
• Amides/therapeutic use
• Anesthetics, Local/therapeutic use
• Double-Blind Method
• Epinephrine/blood
• Female
• Hepatectomy/adverse effects
• Hepatectomy/methods
• Humans
• Hydrocortisone/blood
• Injections, Intralesional
• Length of Stay
• Male
• Middle Aged
• Norepinephrine/blood
• Pain Measurement
• Pain, Postoperative/blood
• Pain, Postoperative/drug therapy
• Pain, Postoperative/etiology
• Postoperative Nausea and Vomiting/epidemiology
• Postoperative Nausea and Vomiting/etiology
• Prospective Studies
• Ropivacaine
• Stress, Physiological/drug effects
• Surgical Wound/complications

• Aged
• Analgesia, Epidural/methods
• Carcinoma, Renal Cell/pathology
• Carcinoma, Renal Cell/surgery
• Female
• Follow-Up Studies
• Humans
• Kaplan-Meier Estimate
• Kidney Neoplasms/pathology
• Kidney Neoplasms/surgery
• Lymphatic Metastasis
• Male
• Middle Aged
• Multivariate Analysis
• Neoplasm Grading
• Neoplasm Metastasis
• Neoplasm Staging
• Nephrectomy/methods
• Proportional Hazards Models
• Retrospective Studies
• Survival Rate

• Humans
• Nerve Block
• Orthopedic Procedures
• Peripheral Nerves

• cancer re-occurrence
• immune function
• inflammation
• local anaesthesia
• metastasis
• neuraxial block

Supplemental Digital Content is Available in the Text.

Analgesics are commonly used to manage pain in cancer patients. It has been suggested that there might be a relation between analgesics and the outgrowth of metastases. Opioids might increase and non-steroidal anti-inflammatory drugs decrease the risk of metastasis. Robust analysis of all preclinical evidence, however, has so far been lacking. Therefore, we conducted a systematic review and meta-analysis on the effect of treatment with analgesics on metastasis in experimental animal models. One hundred forty-seven studies met the inclusion criteria. Study characteristics, outcome data on the number, and incidence of metastases were extracted, and methodological quality was assessed. In the meta-analysis, we included 215 (±4000 animals) and 137 (±3000 animals) comparisons between analgesic vs control treatment, respectively, on the number and incidence of metastases. Overall, treatment with analgesics significantly decreases the number and risk of metastasis. This effect appears mainly to be the consequence of the efficacy of NSAIDs. Other factors that modify the efficacy are species, type of NSAIDs administered, timing, and duration of treatment. There is no evidence indicating that treatment with any analgesics increases the occurrence of metastases. Our findings appear robust for the various animal models and designs included in this review, which increases our confidence in the result and translatability to the clinical situation.