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Top Line: Anesthesia comes with risks, possibly even oncologic ones.
The Study: The authors of this study had the ambitious hypothesis that general anesthesia and the associated physiologic stress response could increase the risk of breast tumor recurrence. And they went to no limits to test it. They recruited over 2000 patients from multiple international centers to be randomized to breast surgery under general anesthesia versus regional anesthesia/analgesia consisting of a paravertebral nerve block and propofol administration. And these weren’t just simple lumpectomies, mind you. These patients were having mastectomies (sometimes bilateral!) and full node dissections. The study follow-up was terminated for futility when it was found there was no likely difference in the rate of cancer recurrence (10%) between groups. Regional anesthesia also did not reduce the rate of severe incisional pain, as it has been purported to do. Roughly a quarter of patients in each arm had incisional pain at one year after surgery with no difference between anesthesia type. The only real difference between arms was an increase in nausea after general anesthesia.
TBL: While there are many benefits to regional anesthesia during breast cancer surgery, reductions in risk of tumor recurrence and incisional pain aren’t among them. | Sessler, Lancet 2019