The potential benefits of the use of regional anesthesia in cancer patients

Abstract

Cancer is a leading cause of morbidity and mortality worldwide. In light of demographic changes among other factors, it is anticipated this trend will continue. Surgical resection is the primary method of treating solid tumours. Unfortunately, even with the use of adjunct therapies, metastatic disease is a leading cause of death in people with cancer. Recent evidence suggests choice of anesthetic technique may influence cancer outcome. This review considers the latest evidence regarding local and regional anesthesia in the context of cancer biology. There is a focus on the indirect and direct mechanisms involved. An integrated approach is used such that diverse areas of research are explored; ranging from epigenetics to cell death pathways. With a better understanding of how regional anesthesia and/or local anesthetics interact with cancer cells, these techniques can be trialed and evaluated to ascertain potential clinical benefits in cancer patients. Thus far, there is insufficient evidence to warrant a change in clinical practice.

Amide-linked local anesthetics induce apoptosis in human non-small cell lung cancer

“…Thus, further studies need to be conducted for the specific mechanisms of opioids on cancer. Apart from the preservation of immune system and the reduction in opioids requirement, systemic administration of local anesthetics during surgery plays a (26,27). One paramount benefit of local anesthetics is that they may induce apoptosis in tumor cells but not in normal tissues (23).…”

Effects of Lidocaine and Ropivacaine on Gastric Cancer Cells Through Down-regulation of ERK1/2 Phosphorylation In Vitro

“…Growing evidence has shown that LAs can reduce the recurrence of cancer by indirect ways. For example, LAs have been shown to cause immunosuppression, stimulate malignant cells in vitro, induce an inflammatory response, and neuroendocrine and metabolic stress (22).…”

“…Lidocaine and ropivacaine are both amide-linked LAs which have been shown to induce apoptosis in human nonsmall cell lung cancer; they provoked DNA damage, upregulated reactive oxygen species (ROS) production and activated mitogen-activated protein kinase (MAPK) pathways (23). Retrospective clinical studies have shown better overall survival of patients after the application of LAs (22). As lidocaine and ropivacaine were widely used for anaesthesia and postoperative analgesia in gastric surgical operations, herein our study aimed to investigate whether lidocaine and ropivacaine have effects on gastric cancer cells.…”

Regional anaesthesia and analgesia: relationship to cancer recurrence and survival

“…They appear to act via several mechanisms, including direct cytotoxicity and induction of apoptosis; inhibition of proliferation, migration, and invasion; and modulation of gene expression via methylation. 45 Local anaesthetics in high concentrations are known to be cytotoxic to neuronal cells 46 ; their toxicity seems to be correlated with lipid solubility and thus with potency. 46 47 Cytotoxicity includes cell death via necrosis or apoptosis.…”