Impact of perioperative pain management on cancer recurrence: an ASRA/ESRA special article

Abstract

Cancer causes considerable suffering and 80% of advanced cancer patients experience moderate to severe pain. Surgical tumor excision remains a cornerstone of primary cancer treatment, but is also recognized as one of the greatest risk factors for metastatic spread. The perioperative period, characterized by the surgical stress response, pharmacologic-induced angiogenesis, and immunomodulation results in a physiologic environment that supports tumor spread and distant reimplantation.In the perioperative period, anesthesiologists may have a brief and uniquewindow of opportunity to modulate the unwanted consequences of the stressresponse on the immune system and minimize residual disease. This reviewdiscusses the current research on analgesic therapies and their impact ondisease progression, followed by an evidence-based evaluation of perioperativepain interventions and medications.

Effect of Ultrasound-Guided Quadratus Lumborum Block Preemptive Analgesia on Postoperative Recovery of Patients with Open Radical Colon Cancer Surgery: A Retrospective Study

“…[1][2][3] Postoperative pain can delay the wound healing, the first ambulation and the recovery of intestinal tract, leading to the patient's body in a stress status, which results in the damage of immune function, thus promoting the recurrence and metastasis of tumor after surgery, and delaying the overall postoperative recovery speed. [4][5][6][7][8][9][10][11][12] It has been demonstrated that scientific and reasonable pain management is helpful to reduce complications and accelerate the recovery of patients. 13 For a long time, opioids have played a major role in postoperative analgesia, but heavy use of these drugs will cause adverse reactions such as nausea, vomiting and enteroparalysis, which is not conducive to rapid recovery after surgery.…”

Mu Opioid Receptor 1 (MOR-1) Expression in Colorectal Cancer and Oncological Long-Term Outcomes: A Five-Year Retrospective Longitudinal Cohort Study

“…Surgical resection is the cornerstone treatment in CRC, however it leads to inflammation, activation of sympathetic nervous system, hypercoagulability, ischemia/reperfusion injury, and suppression of the immune system [3][4][5]. This stress response decreases the host capability to deal with minimal residual disease, increasing the potential risk of local recurrences or metastasis [6][7][8][9].…”

Developing an enhanced recovery after surgery program for oncology patients who undergo hip or knee reconstruction surgery

“…Morphine has a negative effect on the functioning of the immune system and it is strongly recommended to minimize doses[ 70 - 72 ]. MA is of paramount importance in the perioperative period, because it helps to reduce the need for opioids[ 73 ]. Opioid sparing analgesia based on intravenous lidocaine, nonsteroidal anti-inflammatory drugs (NSAIDs) and ketamine has been found to maintain immune function[ 73 ].…”

“…For purpose of pain management, using a combination of NSAIDs or inhibitors of cyclooxygenase-2 (COX-2) with paracetamol (acetaminophen) is recommended to significantly reduce the administration of opioid drugs in the context of a MA[ 21 , 75 , 76 ]. Concomitant use of paracetamol and NSAIDs is the main axis of perioperative MA and one of the most important components of ERAS[ 73 , 76 ]. Studies have shown that MA has great analgesic effects on moderate pain and reduces the additional use of opioids after TKR and THR[ 57 , 77 ].…”