Anaesthetic modality and post-surgical oncological outcomes for paediatric tumours: is there a link?

INTRODUCTION@#Children with solid organ tumours often present for curative surgery. Even with the best surgical technique, micrometastases can occur. Preclinical studies support the postulation that neuraxial anaesthesia maintains the body's immune and inflammatory milieu against metastasis. However, human retrospective adult studies showed varying results, and no study has been done in children. We aimed to find out if intraoperative epidural, perioperative opioid and volatile dose are associated with relapse-free survival (RFS) in children with solid organ tumours.@*METHODS@#This is a retrospective cohort study of 126 children from a tertiary paediatric unit who were diagnosed with solid organ tumours (neuroblastoma, hepatoblastoma or sarcoma) over a 16-year period. RFS, stratified by tumour subtypes, was estimated using the Kaplan-Meier method. Adjusted hazard ratios (aHRs) were obtained from multivariable Cox regression models after taking potential covariates into account.@*RESULTS@#Of 126 children with solid organ tumours (51.6% neuroblastoma, 34.9% sarcoma and 13.5% hepatoblastoma), 53.2% received combined general anaesthesia (GA)/epidural. A total of 21 (31.3%) and 20 (33.9%) patients relapsed during the study period in the combined GA/epidural group and the GA alone group, respectively. Patients with sarcoma receiving combined GA/epidural had a clinically meaningful lower risk of relapse compared to patients receiving GA alone (aHR 0.51, 95% confidence interval 0.14-1.79), although this was not statistically significant.@*CONCLUSION@#Our study demonstrated some clinically meaningful associations, especially in paediatric sarcoma patients. Overall, however, there was no statistically significant association between epidural use and an improved RFS.

Analgesia para cirugía de mama / Analgesia for breast surgery

Resumen: El dolor postoperatorio se espera moderado a severo en las primeras 24 horas después de mastectomía, este dolor puede no resolverse en 10% de las cirugías, y puede persistir hasta después de seis meses en 53% de las pacientes. El síndrome doloroso postmastectomía (SDPM), también llamado neuralgia intercostobraquial, suele presentarse después de una cirugía total o segmentaria, y puede persistir por meses o años, en 20-68% de las pacientes. Inicia en el postoperatorio inmediato, es de intensidad moderada y de características neuropáticas. Los factores asociados con este tipo de dolor además del tipo de cirugía son: la quimioterapia neoadyuvante previa, tumores en cuadrantes superiores, resección mamaria previa, enfermedad metastásica, receptores hormonales positivos, manejo con terapia endocrina, radioterapia y el grado de malignidad del tumor. Nuevas estrategias analgésicas en el perioperatorio han surgido en los últimos años, como son el uso de gabapentinoides, lidocaína y nuevos bloqueos regionales como el bloqueo del plano del erector spinae, bloqueo del serrato, BRILMA, PEC1 y PEC2, las cuales son estrategias efectivas en dolor agudo y que, actualmente, se analiza su impacto a largo plazo (este artículo puede ser consultado en versión completa en http://www.painoutmexico.com).

Abstract: Postoperative pain is moderate to severe in the first 24 hours after mastectomy, this pain may not resolve in 10% of surgeries, and may persist until after six months in 53% of patients. Postmastectomy pain syndrome (SDPM), also called intercosto-brachial neuralgia, may persist for months or years, in 20-68% of patients. It begins in the immediate postoperative period, is of moderate intensity and of neuropathic characteristics. The factors associated with this type of pain as well as the type of surgery are: prior neo-adjuvant chemotherapy, tumors in upper quadrants, previous mammary resection, metastatic disease, positive hormonal receptors, management with endocrine therapy, radiotherapy and the degree of malignancy of the tumor. New analgesic strategies in the perioperative have emerged in recent years, such as: the use of gabapentinoids, lidocaine and new regional blocks such as blockade of the erector spinae plane, serratus blockade, BRILMA, PEC1 and PEC2, which are effective strategies in acute pain and that is currently analyzing its long-term impact (full version is available inhttp://www.painoutmexico.com ) .