The Effects of Anesthetics on Chronic Pain After Breast Cancer Surgery

Abstract

This study showed that propofol anesthesia was associated with a lower incidence of chronic pain after breast cancer surgery than sevoflurane anesthesia. However, propofol did not have a significant effect on severity and duration of chronic pain. Further prospective studies are needed to confirm the validity of these provocative findings.

Effects of intra‐operative maintenance of general anaesthesia with propofol on postoperative pain outcomes – a systematic review and meta‐analysis

“…Besides, propofol can selectively inhibit hyperpolarisation-activated cyclic nucleotide-regulated 1 (HCN1) channels, by which it provides an anti-hyperalgesic effect on chronic pain caused by peripheral nerve injury [34,35]. Another putative mechanism through which propofol may exert its analgesic properties is through desensitisation of transient receptor potential cation channel, subfamily A, member 1 (TRPA1), a receptor involved in the sensation of pain, cold and itch [36]. In vitro evidence has shown that high concentrations of propofol block TRPA1 activation [37].…”

“…In addition to acute postoperative pain, longer-term pain relief has been observed in a clinical trial showing that the incidence of postoperative and newly developed pain was reduced 6 months after thoracotomy using propofol compared with inhalation anaesthesia [29]. Another study in breast cancer surgery also found that propofol was associated with a reduced incidence of chronic postoperative pain [36]. It has also been proposed that propofol might prevent hyperalgesia induced by remifentanil via an NMDA antagonist effect [37].…”

Why anesthesiologists need to care about the way chronic pain is managed

“…18 The use of nitrous oxide has been shown to decrease the risk of chronic postsurgical pain after major noncardiac surgery, 19 and total intravenous anesthesia with propofol and remifentanil may reduce the incidence of chronic postsurgical pain after thoracotomy when compared with inhalation anesthesia. 20 This is an area of anesthesiology that requires further study.…”

“…18 Il a été démontré que l'utilisation de protoxyde d'azote réduisait le risque de douleur chronique postchirurgicale après une chirurgie non cardiaque majeure, et l'anesthésie intraveineuse totale réalisée avec du propofol et du rémifentanil pourrait réduire l'incidence de douleur chronique postchirurgicale après une thoracotomie comparativement à une anesthésie par inhalation. 20 Ce domaine de l'anesthésiologie nécessite des études supplémentaires.…”

General anaesthetic agents do not influence persistent pain after breast cancer surgery

“…8,9 There is also interest in the type of anaesthetic agent used following a recent retrospective report that general anaesthesia under propofol reduced the prevalence of PPSP 1 year after breast cancer surgery, compared with sevoflurane. 10 Such data from observational studies -although they cannot provide evidence of causality -may help advance new hypotheses. To provide more information, we conducted an ancillary analysis of the data from the prospective open-ended French multicentre cohort study EDONIS, which aimed to estimate the risk of occurrence of nPPSP within 6 months after surgery.…”