Scalp block for glioblastoma surgery is associated with lower inflammatory scores and improved survival.

BACKGROUND: Regional anesthesia has anti-inflammatory effects. Recent studies suggest that regional anesthesia might improve the survival of patients with cancer. We hypothesized that the use of a scalp block (SB) during craniotomy for glioblastoma (GB) decreases the postoperative systemic and local inflammatory response and extend their survival. METHODS: This retrospective study included 119 patients with GB who underwent tumor resection. We divided patients into 2 groups based on the use of SB during surgery. Preoperative and postoperative neutrophil-to-lymphocyte (NLR) ratio and platelet-to-lymphocyte (PLR) ratios were calculated as well as the percentage change in postoperative T2/FLAIR (FLuid-Attenuated Inversion Recovery) volume. Both markers of the inflammatory response were compared between patients with and without an SB. Progression-free survival (PFS) was also compared in both groups of patients. Univariate and multivariate analysis were used to test the association between SB and patients' survival. RESULTS: On day 3 after surgery, patients who had an SB showed statistically significant lower NLRs and PLRs than those without an SB. There was also a significant larger reduction in postoperative T2/FLAIR signal in patients with SB than in those without SB. The median PFS (progression-free survival) was longer in patients with SB (16.7 months) than those without an SB (6.5 months, P<0.001). The multivariate analysis indicated that the use of SB was an independent factor for longer PFS (hazard ratio: 0.31 95% confidence interval: 0.07-0.21, P<0.001). CONCLUSIONS: This retrospective study supports the hypothesis that in patients with GB undergoing craniotomy, the use of SB is associated with lower levels of systemic and local inflammation, and longer survival.

A retrospective analysis of the effect of intraoperative opioid dose on cancer recurrence after non-small cell lung cancer resection.

Preclinical studies have demonstrated that opioid receptor agonists increase the rate of non-small cell lung cancer (NSCLC) growth and metastasis. Following institutional review board approval, we retrieved data on 901 patients who underwent surgery for NSCLC at MD Anderson Cancer Center. Comprehensive demographics, intraoperative data, and recurrence-free survival (RFS) and overall survival (OS) at 3 and 5 years were obtained. Cox proportional analyses were conducted to assess the association between intraoperative opioid exposure and RFS and OS. The median intraoperative fentanyl equivalents dosage was 10.15 µg/kg. The multivariate analysis by stage indicated that a trend toward significance for opioid consumption as a risk factor in stage I patients (P = 0.053). No effect was found on RFS for stage II or III patients. Alternatively, opioid consumption was a risk factor for OS for stage I patients (P = 0.036), whereas no effect was noted for stage II or III patients. Intraoperative opioid use is associated with decreased OS in stage I but not stage II-III NSCLC patients. Until randomized controlled studies explore this association further, opioids should continue to be a key component of balanced anesthesia.