Opioids inappropriate for cancer surgery

The methods used to anaesthetise prostate cancer patients and control pain when their prostate glands are surgically removed for adenocarcinoma may affect their long-term cancer outcomes, a study led by Mayo Clinic has found.

Opioids, painkillers commonly given during and after surgery, may suppress the immune system’s ability to fight cancer cells. The research suggests that supplementing general anaesthesia with a spinal or epidural painkiller before a radical prostatectomy reduces a patient’s need for opioids after surgery, and this finding was associated with a lower risk of cancer recurrence. The findings are published online in the British Journal of Anaesthesia.

The immune system’s strength is especially important in cancer surgery because surgical manipulation of a tumour may spread cancer cells. The immune system can be impaired by general anaesthesia, the overall stress surgery places on the body and by post-surgical systemic opioid use.

The study found better outcomes in radical prostatectomy patients who had general anaesthesia supplemented with spinal or epidural delivery of a long-acting opioid such as morphine, than in those who received general anaesthesia only.

“We found a significant association between this opioid-sparing technique, reduced progression of the prostate tumour and overall mortality,” says senior author Juraj Sprung, MD, PhD, a Mayo Clinic anaesthetist.

Researchers used Mayo Clinic’s prostatectomy registry, anaesthesia database and electronic medical records to identify patients who had prostate gland surgery for adenocarcinoma from January 1991 through December 2005. Reports of recurrence of cancer, cancer spread and death were confirmed with patients’ physicians.

While promising, the findings must be tested in randomised trials, Dr Sprung says: “Provided future studies confirm what we’ve found in this study, maybe down the line this would be a standard of care for pain management in patients undergoing cancer surgery.”

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