Regional anaesthesia and analgesia for cancer surgery

The evolution of cancer cells in clinical metastases depends on antimetastatic immune activity and the ability of the tumour to proliferate and generate new blood vessels [neoangiogenesis]. Surgery by itself can depress cellular immunity and functions of cytotoxic T lymphocytes and natural killer [NK] cells. The perioperative stress response releases tumour cells into the circulation and anaesthesia further reduces immune functions, including the functions of neutrophils, macrophages, dendritic cells, T lymphocytes and NK cells. Effective treatment of postoperative pain could play an important role in limiting the metastatic migration following oncology surgery. Opioids used intraoperatively and postoperatively inhibit cellular and humoral immune functions in humans and have natural pro-angiogenic properties. In a retrospective analysis, paravertebral anaesthesia and analgesia for breast cancer surgery reduced the risk of recurrence or metastasis by four during the first years of follow-up. Similarly, following epidural anaesthesia for resection of the prostate, biochemical recurrence of prostate cancer was reduced by 65% and, following colon surgery, the oncological prognosis was enhanced in the first two years. To date there are only retrospective clinical studies available. A prospective, randomized, large-size study focused on cancers with high risk of recurrence is needed to determine if regional anaesthesia and analgesia could have potential for clinically reducing cancer recurrence after oncology surgery

effects of warm and cold intrathecal bupivacaine on shivering during delivery under spinal anesthesia

Shivering associated with neuraxial anesthesia is a common problem that is uncomfortable for patients; it is of unknown ethnology and has no definite treatment. The purpose of this study was to compare the effects of warm intrathecal bupivacaine stored at 23°C and cold intrathecal bupivacaine stored at 4°C on shivering during delivery under spinal anesthesia. Seventy-eight parturient women scheduled for nonemergency cesarean delivery were enrolled in the study and separated into 2 groups. The standard group received 10 mg of heavy bupivacaine 0.5% stored at room temperature [23°C] plus 10 microg of fentanyl intrathecally [warm group], and the case group received 10 mg of heavy bupivacaine 0.5% stored at 4 C plus 10 microg of fentanyl intrathecally [cold group]. Data collection, including sensory block level, blood pressure, core temperature, and shivering intensity, was first performed every minute for 10 min, then every 5 min for 35 min and, finally, every 10 min until the sensory level receded to L4. There were no differences between the 2 groups in the amount of bleeding, pulse rate, oxygen saturation, neonatal Apgar, and incidence of vomiting. The incidence and intensity of shivering decreased in the warm group [P=0.002]. Warming of solutions can reduce the incidence and intensity of shivering in parturient candidates for cesarean delivery under spinal anesthesia