Trial watch: local anesthetics in cancer therapy

Figures & data

Figure 1. Anti-tumor properties of local anesthetics according to the hallmarks of cancer determined by Hanahan and Weinberg. Cancer cells acquire distinct hallmarks that allow them to survive, resist to cell death mechanisms and possess immortality, evade growth suppressors, proliferate, induce angiogenesis, alter the immune system, promote an inflammatory environment, create genome instability, deregulate cellular energetics, and activate invasion and migration processes. Each anti-tumor property of local anesthetics can target one of these acquired hallmarks of cancer cells and hence interfere with the oncogenesis process. EGFR, epithelial growth factor receptor; ER, endoplasmic reticulum; ERK, extracellular signal-regulated kinases; ICD, immunogenic cell death; MMP, matrix metalloproteinase; PI3K/Akt/mTOR, Phosphatidylinositol-3-kinase/Protein kinase B/mammalian target of rapamycin; TGF-β, transforming growth factor β; TRPM7, transient receptor potential melastatin 7; VEGF, vascular endothelial growth factor.

Table 1. Retrospective studies investigating the oncological impact of local anesthetics.

Tumor surgery	Local anesthetic	Design	Results	Ref.
Abdominal	Bupivacaine (epidural)	One hundred and thirty-two patients included (69 with epidural)	No association with RFS	157
Bladder	LA (epidural)	Four hundred and thirty-nine patients involved (215 with epidural).	Do not decrease risk of recurrence (p = .05). Epidural was a predictor of worse RFS (p = .009) and cancer-specific survival (p = .03)	155
Bladder	Lidocaine (intravenous)	One hundred and forty-four patients included.	Higher survival (p = .009). Less recurrence (p = .0023). Independent good prognosis factor (HR = 0.36, 95%CI[0.15–0.90]; p = .029).	146
Bladder	LA (epidural)	One thousand six hundred and twenty-eight patients included (887 epidural)	No benefit in improved short-term outcomes, cancer-specific survival (p = .804) or OS (p = .136)	158
Breast	Levobupivacaine (paravertebral)	One hundred and twenty-nine patients included (50 with paravertebral block)	Association between paravertebral block and RFS (p = .012)	2
Breast	LA (paravertebral)	Seven hundred ninety-two women involved (188 paravertebral)	No benefit in RFS (p = .172)	159
Cervix	LA (neuraxial)	One hundred and thirty-two patients treated with brachytherapy under neuraxial (n = 63) or GA (n = 69).	No benefit in recurrence (p = .863), in long-term mortality from recurrence (p = .265), or in all-cause mortality (p = .209)	160
Colon	LA (peridural)	Eight hundred and seventy-six patients involved (208 peridural)	Do not improve OS (p = .175), cancer-specific survival (p = .111) or DFS (p = .43)	161
Colon	Bupivacaine (epidural)	Two thousand seven hundred and forty-eight patients included (449 epidural)	No association between epidural and recurrence or death	162
Colon	LA (epidural)	Forty-two thousand one hundred and fifty-one patients included (9,670 epidural)	Association between epidural and improved survival (HR = 0.91, 95%CI[0.87–0.94]; p < .001)	138
Colo-rectal	LA (epidural)	Five hundred and eighty-eight patients involved (399 epidural).	Better five-year survival (p = .01)	3
Colo-rectal	LA (epidural)	Five hundred and nine patients enrolled (256 epidural).	Less recurrence in the subgroup of older patients (p = .01).	141
Colo-rectal	LA (epidural)	Six hundred and fifty-five patients included in two groups: epidural (n = 562) vs PCA (n = 93)	Reduction in all-cause mortality after rectal cancer surgery (p = .049).	142
Colo-rectal	LA (peridural)	Patients included into two groups (442 GA+peridural/307 GA alone)	Better 5-year survival (p = .02). HR for death decreased by 27%. In ASA 3–4 patients, significant greater survival (p < .009)	134
Colo-rectal	Bupivacaine (epidural)	Five hundred and ten patients involved (390 epidural)	Better 5-year RFS (HR = 0.74, 95%CI[0.56–0.95]; p = .036)	139
Colo-rectal	LA (epidural)	Two thousand nine hundred and eighty patients in each group after matching.	No benefit for mortality and recurrence.	163
Colo-rectal	Bupivacaine (epidural or spinal)	Four hundred and twenty-four patients included (107 epidural, 144 spinal, 173 PCA)	No difference in OS (p = .622) or DFS (p = .49) at 5 years	164
Colo-rectal	Bupivacaine (epidural)	Nine hundred and ninety-nine patients included (165 epidural)	No association between epidural and RFS or OS	165
Colo-rectal	Ropivacaine (epidural)	Two hundred and twenty-five patients included (92 epidural)	GA was associated with better outcomes	145
ENT	LA (epidural)	One hundred and seventy-one patients involved (111 epidural)	Increase DFS (HR = 0.49, 95%CI[0.25–0.96]; p = .04). Increase OS (p = .03)	143
Esophagus	Ropivacaine (epidural)	One hundred and fifty-three patients included (118 epidural)	No benefit in recurrence, 1-year mortality, or 5-year survival	166
Esophagus	LA (epidural)	One thousand nine hundred and twenty-one patients included (1,169 epidural)	Epidural improved 5-year survival (p = .012)	148
Esophagus	Ropivacaine (epidural)	Three hundred and fifty-six patients included (178 epidural)	Epidural decreased the incidence of pneumonia (p = .008), anastomotic leakage (p = .029), CRP level (p = .044). No benefits in recurrence (p = .47) or OS (p = .46)	149
Gastric	LA (epidural)	Two thousand seven hundred and forty-five patients (766 epidural)	No benefits in recurrence or survival	167
Gastric	Ropivacaine (epidural)	Three thousand seven hundred and ninety-nine patients included (3,425 epidural)	No benefits in recurrence (p = .471) or mortality (p = .138)	181
Gastric	Ropivacaine or levobupivacaine (epidural)	Two hundred and seventy-three patients included (157 epidural)	Greater long-term survival among younger patients<64 years-old (p = .042)	150
Gastric	LA (epidural)	One hundred and ninety-four patients included (97 epidural)	No benefit in survival (p = .147)	168
Gastro-esophageal	Bupivacaine (epidural)	One hundred and forty patients involved with epidural (n = 97) or not (n = 43).	Less recurrence (p = .01). Increased time to recurrence (HR = 0.33, 95%CI[0.17–0.63]; p < .0001). Better OS (HR = 0.42; 95%CI[0.16–0.75]; p = .005). Improved median time to death (p = .029)	140
Liver	Lidocaine (local injection)	Four hundred and eighty-nine patients involved (245 local injection).	Less recurrence (p = .0022). Less mortality (p = .036)	137
Liver	Bupivacaine (epidural)	Seven hundred and forty-four patients included (435 epidural)	No association between epidural and recurrence or mortality	169
Liver	Ropivacaine (epidural)	Eight hundred and nineteen patients included (451 epidural)	More recurrence (p = .036) and more death (p = .003) with epidural. No impact on RFS (p = .509)	156
Lung	Bupivacaine or ropivacaine (epidural)	Four hundred and forty-five patients involved (343 epidural /23 PCA/79 epidural + PCA)	No benefit in 2-year or 5-year RFS or OS	170
Lung	Bupivacaine (epidural)	Two thousand one hundred and ninety-one patients included (1,799 epidural)	No benefit in long-term mortality or OS	171
Melanoma	Bupivacaine (spinal anesthesia)	Two hundred and seventy-five patients included (52 spinal anesthesia + GA)	No benefit in survival (p = .087)	172
Ovary	LA (epidural)	One hundred eighty-two patients included (55 epidural).	Increased time to recurrence after surgery.	151
Ovary	Bupivacaine (neuraxial)	Eighty patients involved (37 epidural).	No benefit in OS or recurrence	173
Ovary	Lidocaine (intravenous)	Six hundred and four patients included after matching (302 lidocaine intravenous vs 302 without lidocaine)	Improved DFS (p = .015) and OS (p = .042)	147
Ovary	Bupivacaine or ropivacaine (epidural)	One hundred and forty-three patients included (106 epidural)	Better 3 – and 5-year OS (HR = 1.214; p = .043)	135
Ovary	LA (epidural)	One hundred and ninety-four patients included (60 epidural)	Less recurrence (p = .028). Longer DFS was associated with more than 48 h of epidural	152
Ovary	LA (epidural)	Six hundred and forty-eight patients included (435 epidural)	Better PFS (p = .021) and OS (p < .001). Epidural is independently associated with a decreased risk of progression (HR = 1.327, 95%CI[1.066–1.653]) and death (HR = 1.588, 95%CI[1.224–2.06])	153
Ovary	Ropivacaine (epidural)	One hundred and four patients included (51 epidural)	No benefits in DFS or OS	174
Pancreas	Lidocaine (intravenous)	Two thousand two hundred and thirty-nine patients involved. After propensity score: lidocaine (n = 915) or not (n = 915)	Benefit in 1-year OS (p < .001) and 3-year OS (p = .011). Lidocaine was associated with prolonged OS (HR = 0.616; 95%CI[0.29–0.783]; p = .013)	136
Pancreas	Ropivacaine (epidural)	Two hundred and fifteen patients included. 11 patients with high concentration of LA (0.375–0.5%) and 96 patients with low concentration (0.15–0.25%)	High concentration of ropivacaine improved OS (p = .04) and was an independent good prognostic factor (HR = 0.65, 95%CI[0.44–0.94]; p = .03)	154
Pancreas	Bupivacaine (epidural)	Two hundred and fifty-two patients included (n = 88 epidural; n = 164 without epidural)	No association with greater recurrence (p = .87) or all-cause mortality (p = .85).	175
Pancreas	Ropivacaine (peridural)	Ninety-eight patients included (70 peridural)	No benefits in recurrence or OS	176
Prostate	Bupivacaine (epidural)	One hundred and forty-eight patients involved (67 epidural)	Do not reduce the risk of progression. Do not improve survival.	177
Prostate	LA (epidural)	Two hundred and twenty-five patients included (102 epidural)	Lower risk of recurrence (p = .012)	1
Prostate	Bupivacaine (epidural)	Two hundred and sixty-one patients included (103 epidural)	Benefit in PFS (HR = 0.45; p = .002)	144
Prostate	LA (epidural)	One thousand one hundred and eleven patients included (578 epidural)	No benefit	178
Prostate	LA (epidural)	Ninety-nine patients included (49 epidural)	No benefit in recurrence (HR = 1.33, 95%CI[0.64–2.77]; p = .44)	179
Rectum	Bupivacaine (epidural)	One thousand two hundred and eighty-two patients included (237 epidural)	No association with RFS (p = .491) or OS (p = .984) or cancer-specific survival (p = .482)	180

Abbreviations: ASA, American society of anesthesiologists (physical status score); CI, confidence interval; CRP, C-reactive protein; DFS, disease-free survival; GA, general anesthesia; HR, hazard ratio; LA, local anesthetics; PCA, patient-controlled analgesia; OS, overall survival; PFS, progression-free survival; RFS, recurrence-free survival

Table 2. Meta-analyses investigating the oncological impact of local anesthetics.

Tumor surgery	Local anesthetic	Design	Results	Ref.
Solid tumors	LA (epidural)	Ten studies (=3,254 patients) included.	Subgroups with prostate cancer or follow-up less than or equal to two years (OR = 0.66, 95%CI[0.46–0.95], p = .027; OR = 0.70, 95%CI[0.51–0.98], p = .035; respectively) for recurrence and metastasis rate	183
Solid tumors	LA (regional anesthesia)	Twenty studies	Improve OS (HR = 0.84; 95%CI[0.75–0.94; I^2 = 41%] No reduction in recurrence (HR = 0.91, 95%CI[0.70–1.18; I^2 = 83%]	184
Solid tumors	LA (neuraxial)	Twenty-one studies involved (15,160 patients with neuraxial anesthesia and 36,460 with GA)	Improved OS (HR = 0.853, 95%CI[0.741–0.981]; p = .026) Improve RFS (HR = 0.846, 95%CI[0.718–0.998]; p = .047)	185
Solid tumors	LA (epidural)	Fourteen studies (47,000 patients) included	Improved OS (p = .013)	182

Abbreviations: CI, confidence interval; GA, general anesthesia; HR, hazard ratio; LA, local anesthetics; OR, odds ratio; OS, overall survival; RFS, recurrence-free survival

Table 3. Prospective randomized controlled trials investigating the oncological outcomes of local anesthetics.

Tumor surgery	Local anesthetic	Design	Results	Ref.
Bladder	Ropivacaine + lidocaine (epidural)	One hundred patients included (50 with epidural)	Longer DFS (p = .02)	198
Breast	Levobupivacaine (paravertebral)	Twenty-two patients randomized to receive propofol/paravertebral or sevoflurane/opioid	The serum of patients from the group paravertebral inhibits the proliferation of ER-MDA-MB-231 breast cancer cells in vitro.	204
Breast	Bupivacaine (paravertebral)	Forty patients randomized to receive paravertebral block or not.	Less increase in IL-6. Higher level in IFN-γ.	115
Breast	Ropivacaine (paravertebral)	One hundred and eighty patients randomized to receive paravertebral block or not.	Do not decrease recurrence or mortality	187
Breast	Ropivacaine (paravertebral)	Sixty patients involved to receive paravertebral block or not.	Do not decrease recurrence	188
Breast	Ropivacaine+ lidocaine (local injection)	Fifty-six patients randomized to receive local anesthesia or GA	Higher total lymphocytes number in GA group (p = .04)	205
Breast	Lidocaine (peritumoral)	One thousand five hundred and eighty-three patients randomized to receive lidocaine (n = 796) or not (n = 804)	Better 5-year DFS (HR = 0.74, 95%CI[0.58–0.95]; p = .017) and OS (HR = 0.71, 95%CI[0.53–0.94]; p = .019)	203
Breast	LA (paravertebral)	Two thousand one hundred and eight patients included (1,043 with paravertebral block)	No difference between groups	189
Cervix	Lidocaine (bolus and continuous intravenous infusion)	Thirty women randomized to receive lidocaine iv or normal saline.	Increase in the proliferation of lymphocytes. Decrease in apoptosis of lymphocytes. Better level of INF-γ	105
Colon	Bupivacaine (epidural)	One hundred and seventy-seven patients randomized to receive epidural or not.	Epidural improved survival before 1.46 years (p = .012)	199
Colon	Ropivacaine (epidural)	Forty patients randomized to receive epidural or not.	Decreased in VEGF (p = .001), TGF-β (p = .027) and IL-6 (p = .007). Increased in IL-10 (p = .001).	206
Colon	Ropivacaine (intraperitoneal catheter)	Thirty-seven patients randomized to receive LA through intraperitoneal catheter (n = 19) or not (n = 18).	No benefit in OS or all-cause mortality. Higher rate of cancer-specific mortality (p < .046)	190
Colo-rectal	Ropivacaine (intraperitoneal catheter)	Sixty patients included (30 with infiltration)	No effect on NK cytotoxicity, recurrence or metastases	191
Colo-rectal	LA (epidural)	One hundred and eighty patients randomized to receive epidural (n = 89) or PCA (n = 91).	No significant difference for DFS at 5 years	192
Colo-rectal	Lidocaine (intravenous)	Eighty-two patients randomized to receive lidocaine or not with or without ketamine.	No influence on inflammatory markers.	197
Colo-rectal	Lidocaine (intravenous)	One hundred and fifty patients randomized to receive lidocaine (n = 77) or not (n = 73).	Decreased rate of recurrence (p = .03) but no impact on 1-year survival (p = .22)	200
ENT	Ropivacaine (epidural)	Thirty patients randomized to receive epidural or not.	Reduction in blood glucose (p = .0153) and cortisol (p = .0074)	118
Gastric	Ropivacaine (epidural)	Fifty patients randomized to receive epidural or not.	Increased in IFN-γ. Less increase in IL-6.	207
Liver	Ropivacaine (bolus+ infiltration)	Sixty patients included (20 with tramadol, 20 with ropivacaine, 20 with fentanyl)	Ropivacaine increased survival (p = .029)	201
Lung	Ropivacaine (paravertebral)	Forty patients involved to receive paravertebral/propofol vs sevoflurane	Lower VEGF and TGF-β concentration (p < .05)	208
Lung	Ropivacaine (paravertebral)	One hundred and fifty-nine patients randomized to receive ropivacaine (10 mg or 25 mg or 50 mg)	No influence on OS	193
Lung	Ropivacaine (epidural)	Four hundred patients included (200 with epidural)	No benefits in RFS or OS	194
Ovary	Ropivacaine (intraperitoneal catheter)	Forty patients randomized to have intraperitoneal catheter of LA or not	Serum cortisol was lower in LA group (p = .023)	209
Ovary	Ropivacaine (intraperitoneal catheter)	Forty women involved to receive intraperitoneal catheter or not.	Reduction of time to initiate chemotherapy after surgery (p = .021)	202
Pancreas	Lidocaine (intravenous)	Five hundred and sixty-three patients randomized to receive lidocaine intravenous (n = 283) or not (n = 280)	No association with better OS (p = .79) or DFS (p = .44)	195
Prostate	Ropivacaine (epidural)	Ninety-nine patients randomized to receive epidural/GA or GA alone.	No difference in DFS.	179
Solid tumors	Bupivacaine or Ropivacaine (epidural)	Four hundred and forty-six patients included (230 with epidural)	No benefits in DFS	186
Solid tumors	Ropivacaine (epidural)	One thousand seven hundred and twelve patients included (853 with epidural)	No benefits in OS	196

Abbreviations: DFS, disease-free survival; GA, general anesthesia; HR, hazard ratio; iv, intravenous; IFN, interferon; IL, interleukin; LA, local anesthetic; NK, natural killer cells; OS, overall survival; PCA, patient-controlled analgesia; RFS, recurrence-free survival; TGF, tumor growth factor; VEGF, vascular endothelial growth factor

Table 4. Completed and terminated prospective trials investigating the oncological outcomes of local anesthetics.

Tumor surgery	Local anesthetic	Administration route	Oncological endpoints	Potential endpoints related to cancer outcome	Phase	Status	Ref.
Breast	Lidocaine	Intravenous	5-year recurrence	Chronic pain Opioid use	2	completed	NCT01204242
Breast	LA	Epidural or Regional (paravertebral)	10-year recurrence	Postsurgical pain Neuropathic pain	3	completed	NCT00418457
Breast	LA	Regional	Circulating tumor cells, level of cytokines, breast cancer antibodies, dendritic cells, T, B and NK cells		Obser-vational	completed	NCT01716065
Breast	Ropivacaine vs lidocaine	Regional (paravertebral)	Recurrence up to 12 months	Postoperative pain	NA	completed	NCT04390698
Breast	Ropivacaine	Regional	Mortality 3 – and 5-year recurrence	Opioid use, actual/chronic pain	NA	completed	NCT03117894
Breast	Ropivacaine	Regional (continuous infusion for 3 days)	3-year cancer recurrence	Opioid use Pain	4	completed	NCT01231204
Colo-rectal	Ropivacaine	Epidural	5-year mortality 7-year recurrence	Inflammation (perioperative cytokine concentration in blood), postoperative pain	3	terminated	NCT01318161
Colo-rectal	Ropivacaine	Infiltration	1-year recurrence, NK cell activity	Inflammatory responses, IL-2 level	NA	completed	NCT02012244
Liver	Lidocaine	Sub-cutaneous	Percentage change from post – to pre-operative values of HepG2 cells; Invasion, migration and proliferation of HepG2 cells cultured in patients’ serum	IL-1β, IL-6, TNF-α, IFN-γ and IL-2 level	NA	completed	NCT04510935
Liver	LA	Local	Cell proliferation Cell migration and metastasis		NA	completed	NCT03594188
Lung	LA	Epidural	4-year RFS, mortality, OS, number of CD8^+ and Treg in tumor, percentage of NK and T-cell in blood	Pain	NA	completed	NCT02801409
Lung	LA	Epidural	5-year disease-free survival, NK cell function, immune function markers,	Pain	NA	terminated	NCT01179308
Ovary	Ropivacaine	Intraperitoneal	PFS, morbidity	Inflammatory markers, opioid use, pain	3	completed	NCT02256228
Pancreas	Bupivacaine	Epidural	Immunoprofile (CD4^+, CD8^+, CD19^+, NK, DC, Treg), 1-year survival		NA	completed	NCT01929915
Prostate	Bupivacaine + ropivacaine	Epidural	NK activity	Release of IL-2, IL-6, TNF-α, cortisol	3	completed	NCT01367418

Abbreviations: DC, dendritic cell; IFN, interferon; IL, interleukin; LA, local anesthetics; NA, non-applicable; NK, natural killer; OS, overall survival; PFS, progression-free survival; RFS, recurrence-free survival; TNF, tumor necrosis factor; Treg, regulatory T cells

Table 5. Ongoing prospective trials investigating the oncological outcomes of local anesthetics.

Tumor surgery	Local anesthetic	Administration	Oncological endpoints	Other endpoints potentially related to cancer outcome	Phase	Status	Ref.
Abdominal tumor	Bupivacaine	Epidural	NK cytotoxicity		NA	enrolling by invitation	NCT02669186
Bladder	Bupivacaine	Spinal	2-year RFS 2-year PFS		NA	unknown	NCT03597087
Bladder	Bupivacaine	Regional (obturator nerve block)	Recurrent tumor at 3 months		NA	recruiting	NCT04638569
Breast	Lidocaine + bupivacaine	Tumor site	5-year DFS	Pain, opioid use	3	unknown	NCT00938171
Breast	Lidocaine	Peri-tumoral	5-year DFS 5-year OS		3	not yet recruiting	NCT01916317
Breast	Ropivacaine	Regional (erector spinae plane)	3-year PFS 3-year OS	Chronic pain, neuropathic pain	NA	not yet recruiting	NCT05494502
Breast	LA	Regional (paravertebral)	Genome expression by microarray, immune progenitors, 7-year RFS 7-year OS		NA	unknown	NCT03779685
Breast	Bupivacaine	Regional (paravertebral)	Change in level of PD-1 and PD-L1 on peripheral blood monocyte cells	Total analgesia (paracetamol)	NA	unknown	NCT04657237
Colo-rectal	Lidocaine	Intravenous	Antiproliferative and apoptotic effects of anesthetics, evaluation of patient serum on colon cancer cell culture (HCT116) 5-year survival	Lidocaine concentration	1	recruiting	NCT04162535
Colo-rectal	Lidocaine	Intravenous	5-year survival, 5-year recurrence	Pain, opioid use	Early 1	recruiting	NCT02786329
Colo-rectal	Lidocaine	Intravenous	NK activity	Pain, opioid use	4	unknown	NCT01841294
Glio-blastoma	LA	Local	Morbidity, resection percentage, progression-free survival, OS, residual tumor volume		Obser-vational	recruiting	NCT04708171
Liver	LA	Infiltration vs epidural	3 – and 5-year OS 5-year DFS		NA	unknown	NCT03813953
Liver	LA	Local	3-year recurrence		Obser-vational	unknown	NCT02474511
Lung	LA	Epidural	3-year DFS	Pain, opioid use	NA	not yet recruiting	NCT02840227
Melanoma	Bupivacaine	Spinal	OS, change of total amount of immune cells (T-, B-, NK-cells), changes in TGF-β, activation of thrombocytes, potential predictive biomarkers		NA	unknown	NCT01588847
Ovary	Ropivacaine	Intraperitoneal	Time to start of adjuvant chemotherapy after surgery, 3-5-year survival, morbidity		3	recruiting	NCT04065009
Pancreas	Lidocaine	Intravenous	NK level, lymphocytes level	Pain, analgesic consumption	NA	recruiting	NCT05470166
Pancreas	Lidocaine	Intravenous	Src tyrosine kinase activity in circulating tumor cells, cytokine/chemokine levels in serum, regulation of gene expression, circulating tumor cells		Early 1	recruiting	NCT04048278
Pancreas	Lidocaine vs ropivacaine	Intravenous vs Epidural	1 – and 3-year recurrence 1 – and 3-year survival after surgery	LA concentration	2	not yet recruiting	NCT04449289
Solid tumors	Ropivacaine + lidocaine	Regional	5-year recurrence, 5-year survival, percentage of immunocytes and cytokines	Intraoperative anesthetic level, pain	NA	not yet recruiting	NCT03134430

Abbreviations: DC, dendritic cell; DFS, disease-free survival; LA, local anesthetics; NA, non-applicable; NK, natural killer cells; OS, overall survival; PD(L)1, Programmed cell Death (Ligand) protein 1; PFS, progression-free survival; RFS, recurrence-free survival; TGF, tumor growth factor

Binczak M, Tournay E, Billard V, Rey A, Jayr C. Major abdominal surgery for cancer: does epidural analgesia have a long-term effect on recurrence-free and overall survival? Ann Fr Anesth Reanim. 2013;32(5):e81–8. doi:10.1016/j.annfar.2013.02.027.

 PubMedGoogle Scholar

Chipollini J, Alford B, Boulware DC, Forget P, Gilbert SM, Lockhart JL, Pow-Sang JM, Sexton WJ, Spiess PE, Poch MA, et al. Epidural anesthesia and cancer outcomes in bladder cancer patients: is it the technique or the medication? A matched-cohort analysis from a tertiary referral center. BMC Anesthesiol. 2018;18(1):157. doi:10.1186/s12871-018-0622-5.

 PubMedGoogle Scholar

Cazenave L, Faucher M, Tourret M, Marques M, Tezier M, Mokart D. Intravenous lidocaine and cancer outcomes after radical cystectomy. Eur. J. Anaesthesiol. 2022;39(4):396–399. doi:10.1097/EJA.0000000000001559.

 PubMed Web of Science ®Google Scholar

Christopher Doiron R, Jaeger M, Booth CM, Wei X, Robert Siemens D. Is there a measurable association of epidural use at cystectomy and postoperative outcomes? a population-based study. Can Urol Assoc J. 2016;10(9–10):321–327. doi:10.5489/cuaj.3856.

 PubMed Web of Science ®Google Scholar

Exadaktylos AK, Buggy DJ, Moriarty DC, Mascha E, Sessler DI. Can anesthetic technique for primary breast cancer surgery affect recurrence or metastasis? Anesthesiol. 2006;105(4):660–664. doi:10.1097/00000542-200610000-00008.

 PubMed Web of Science ®Google Scholar

Cata JP, Chavez-MacGregor M, Valero V, Black W, Black DM, Goravanchi F, Ifeanyi IC, Hernandez M, Rodriguez-Restrepo A, Gottumukkala V. The impact of paravertebral block analgesia on breast cancer survival after surgery. Reg Anesth Pain Med. 2016;41(6):696–703. doi:10.1097/AAP.0000000000000479.

 PubMed Web of Science ®Google Scholar

Ismail H, Ho KM, Narayan K, Kondalsamy-Chennakesavan S. Effect of neuraxial anaesthesia on tumour progression in cervical cancer patients treated with brachytherapy: a retrospective cohort study. Br J Anaesth. 2010;105(2):145–149. doi:10.1093/bja/aeq156.

 PubMed Web of Science ®Google Scholar

Wurster EF, Pianka F, Warschkow R, Antony P, Brenner T, Weigand MA, Schmied BM, Buchler MW, Tarantino I, Ulrich A. Peridural analgesia does not impact survival in patients after colon cancer resection: a retrospective propensity score-adjusted analysis. Int. J. Colorectal Dis. 2019;34(7):1283–1293. doi:10.1007/s00384-019-03315-0.

 PubMed Web of Science ®Google Scholar

Wu HL, Tai YH, Mandell MS, Tsou MY, Yang SH, Chen TH, Chang KY. Effect of epidural analgesia on cancer prognosis after colon cancer resection: a single-centre cohort study in Taiwan. BMJ open. 2020;10(10):e036577. doi:10.1136/bmjopen-2019-036577.

 PubMed Web of Science ®Google Scholar

Cummings KC 3rd, Xu F, Cummings LC, Cooper GS. A comparison of epidural analgesia and traditional pain management effects on survival and cancer recurrence after colectomy: a population-based study. Anesthesiol. 2012;116(4):797–806. doi:10.1097/ALN.0b013e31824674f6.

 PubMed Web of Science ®Google Scholar

Vogelaar FJ, Abegg R, van der Linden Jc, Cornelisse HG, van Dorsten Fr, Lemmens VE, Bosscha K, van der Linden JC, van Dorsten FRC. Epidural analgesia associated with better survival in colon cancer. Int J Colorectal Dis. 2015;30(8):1103–1107. doi:10.1007/s00384-015-2224-8.

 PubMed Web of Science ®Google Scholar

Gottschalk A, Ford JG, Regelin CC, You J, Mascha EJ, Sessler DI, Durieux ME, Nemergut EC. Association between epidural analgesia and cancer recurrence after colorectal cancer surgery. Anesthesiol. 2010;113(1):27–34. doi:10.1097/ALN.0b013e3181de6d0d.

 PubMed Web of Science ®Google Scholar

Gupta A, Bjornsson A, Fredriksson M, Hallbook O, Eintrei C. Reduction in mortality after epidural anaesthesia and analgesia in patients undergoing rectal but not colonic cancer surgery: a retrospective analysis of data from 655 patients in central Sweden. Br J Anaesth. 2011;107(2):164–170. doi:10.1093/bja/aer100.

 PubMed Web of Science ®Google Scholar

Holler JP, Ahlbrandt J, Burkhardt E, Gruss M, Rohrig R, Knapheide J, Hecker A, Padberg W, Weigand MA. Peridural analgesia may affect long-term survival in patients with colorectal cancer after surgery (PACO-RAS-Study): an analysis of a cancer registry. Ann Surg. 2013;258(6):989–993. doi:10.1097/SLA.0b013e3182915f61.

 PubMed Web of Science ®Google Scholar

Zimmitti G, Soliz J, Aloia TA, Gottumukkala V, Cata JP, Tzeng CW, Vauthey JN. Positive impact of epidural analgesia on oncologic outcomes in patients undergoing resection of colorectal liver metastases. Ann Surg Oncol. 2016;23(3):1003–1011. doi:10.1245/s10434-015-4933-1.

 PubMed Web of Science ®Google Scholar

Hasselager RP, Hallas J, Gogenur I. Epidural analgesia and recurrence after colorectal cancer surgery: a danish retrospective registry-based cohort study. Anesthesiol. 2022;136(3):459–471. doi:10.1097/ALN.0000000000004132.

 PubMed Web of Science ®Google Scholar

Day A, Smith R, Jourdan I, Fawcett W, Scott M, Rockall T. Retrospective analysis of the effect of postoperative analgesia on survival in patients after laparoscopic resection of colorectal cancer. Br J Anaesth. 2012;109(2):185–190. doi:10.1093/bja/aes106.

 PubMed Web of Science ®Google Scholar

Tai YH, Chang WK, Wu HL, Chan MY, Chen HH, Chang KY, Ahmad A. The effect of epidural analgesia on cancer progression in patients with stage IV colorectal cancer after primary tumor resection: a retrospective cohort study. PloS one. 2018;13(7):e0200893. doi:10.1371/journal.pone.0200893.

 PubMed Web of Science ®Google Scholar

Gao H, Meng XY, Wang HQ, Zhu FF, Guo AL, Zhu M, Song JC, Yu WF. Association between anaesthetic technique and oncological outcomes after colorectal carcinoma liver metastasis resection. Int. J. Med. Sci. 2019;16(2):337–342. doi:10.7150/ijms.28016.

 PubMed Web of Science ®Google Scholar

Merquiol F, Montelimard AS, Nourissat A, Molliex S, Zufferey PJ. Cervical epidural anesthesia is associated with increased cancer-free survival in laryngeal and hypopharyngeal cancer surgery: a retrospective propensity-matched analysis. Regional Anesthesia and Pain Medicine. 2013;38(5):398–402. doi:10.1097/AAP.0b013e31829cc3fb.

 PubMedGoogle Scholar

Heinrich S, Janitz K, Merkel S, Klein P, Schmidt J. Short- and long term effects of epidural analgesia on morbidity and mortality of esophageal cancer surgery. Langenbeck’s Arch. Surg. 2015;400(1):19–26. doi:10.1007/s00423-014-1248-9.

 PubMed Web of Science ®Google Scholar

Cummings Iii KC, Kou TD, Chak A, Schluchter MD, Margevicius S, Cooper GS, Meropol NJ, Perry Y, Linden PA, Cummings LC. Surgical approach and the impact of epidural analgesia on survival after esophagectomy for cancer: a population-based retrospective cohort study. PLoS One. 2019;14(1):e0211125. doi:10.1371/journal.pone.0211125.

 PubMed Web of Science ®Google Scholar

Li W, Li Y, Huang Q, Ye S, Rong T. Short and long-term outcomes of epidural or intravenous analgesia after esophagectomy: a propensity-matched cohort study. PLoS One. 2016;11(4):e0154380. doi:10.1371/journal.pone.0154380.

 PubMed Web of Science ®Google Scholar

Cummings KC 3rd, Patel M, Htoo PT, Bakaki PM, Cummings LC, Koroukian S. A comparison of the effects of epidural analgesia versus traditional pain management on outcomes after gastric cancer resection: a population-based study. Reg Anesth Pain Med. 2014;39(3):200–207. doi:10.1097/AAP.0000000000000079.

 PubMed Web of Science ®Google Scholar

Shin S, Kim HI, Kim NY, Lee KY, Kim DW, Yoo YC. Effect of postoperative analgesia technique on the prognosis of gastric cancer: a retrospective analysis. Oncotarget. 2017;8(61):104594–104604. doi:10.18632/oncotarget.21979.

 PubMedGoogle Scholar

Wang J, Guo W, Wu Q, Zhang R, Fang J. Impact of combination epidural and general anesthesia on the long-term survival of gastric cancer patients: a retrospective study. Med Sci Monit. 2016;22:2379–2385. doi:10.12659/msm.899543.

 PubMed Web of Science ®Google Scholar

Pei JP, Zhang CD, Liang Y, Zhang C, Wu KZ, Zhao ZM, Dai DQ. Effects of epidural combined with general anesthesia versus general anesthesia alone in gastric cancer surgery: a propensity score matching analysis. Ann Transl Med. 2020;8(7):473. doi:10.21037/atm.2020.03.127.

 PubMed Web of Science ®Google Scholar

Hiller JG, Hacking MB, Link EK, Wessels KL, Riedel BJ. Perioperative epidural analgesia reduces cancer recurrence after gastro-oesophageal surgery. Acta Anaesthesiol Scand. 2014;58(3):281–290. doi:10.1111/aas.12255.

 PubMed Web of Science ®Google Scholar

Wang X, Xie W, Gan S, Wang T, Chen X, Su D, Sun J, Lin J, Wu F, Xu P, et al. Effects of general anesthesia versus local anesthesia in primary hepatocellular carcinoma patients presenting for thermal ablation surgery: a multiple center retrospective cohort study with propensity score matching. Ann Transl Med. 2020;8(6):277. doi:10.21037/atm.2020.03.88.

 PubMed Web of Science ®Google Scholar

Chang WK, Lee MY, Tai YH, Kuo YM, Tsou MY, Chang KY. Does epidural analgesia improve the cancer outcome in hepatocellular carcinoma after resection surgery? A retrospective analysis. J Chin Med Assoc. 2019;82(4):295–299. doi:10.1097/JCMA.0000000000000054.

 PubMed Web of Science ®Google Scholar

Cao L, Chang Y, Lin W, Zhou J, Tan H, Yuan Y, Zeng W. Long-term survival after resection of hepatocelluar carcinoma: a potential risk associated with the choice of postoperative analgesia. Anesth Analg. 2014;118(6):1309–1316. doi:10.1213/ANE.0000000000000207.

 PubMed Web of Science ®Google Scholar

Cata JP, Gottumukkala V, Thakar D, Keerty D, Gebhardt R, Liu DD. Effects of postoperative epidural analgesia on recurrence-free and overall survival in patients with nonsmall cell lung cancer. J Clin Anesth. 2014;26(1):3–17. doi:10.1016/j.jclinane.2013.06.007.

 PubMed Web of Science ®Google Scholar

Wu HL, Tai YH, Chan MY, Tsou MY, Chen HH, Chang KY. Effects of epidural analgesia on cancer recurrence and long-term mortality in patients after non-small-cell lung cancer resection: a propensity score-matched study. BMJ open. 2019;9(5):e027618. doi:10.1136/bmjopen-2018-027618.

 PubMed Web of Science ®Google Scholar

Gottschalk A, Brodner G, Van Aken HK, Ellger B, Althaus S, Schulze HJ. Can regional anaesthesia for lymph-node dissection improve the prognosis in malignant melanoma? Br J Anaesth. 2012;109(2):253–259. doi:10.1093/bja/aes176.

 PubMed Web of Science ®Google Scholar

de Oliveira Gs AS Jr., Schink JC, Singh DK, Fitzgerald PC, McCarthy RJ, McCarthy RJ. Intraoperative neuraxial anesthesia but not postoperative neuraxial analgesia is associated with increased relapse-free survival in ovarian cancer patients after primary cytoreductive surgery. Reg Anesth Pain Med. 2011;36(3):271–277. doi:10.1097/AAP.0b013e318217aada.

 PubMed Web of Science ®Google Scholar

Lacassie HJ, Cartagena J, Branes J, Assel M, Echevarria GC. The relationship between neuraxial anesthesia and advanced ovarian cancer-related outcomes in the Chilean population. Anesth Analg. 2013;117(3):653–660. doi:10.1213/ANE.0b013e3182a07046.

 PubMed Web of Science ®Google Scholar

Zhang H, Gu J, Qu M, Sun Z, Huang Q, Cata JP, Chen W, Miao C. Effects of intravenous infusion of lidocaine on short-term outcomes and survival in patients undergoing surgery for ovarian cancer: a retrospective propensity score matching study. Front Oncol. 2021;11:689832. doi:10.3389/fonc.2021.689832.

 PubMed Web of Science ®Google Scholar

Lin L, Liu C, Tan H, Ouyang H, Zhang Y, Zeng W. Anaesthetic technique may affect prognosis for ovarian serous adenocarcinoma: a retrospective analysis. Br J Anaesth. 2011;106(6):814–822. doi:10.1093/bja/aer055.

 PubMed Web of Science ®Google Scholar

Elias KM, Kang S, Liu X, Horowitz NS, Berkowitz RS, Frendl G. Anesthetic selection and disease-free survival following optimal primary cytoreductive surgery for stage III epithelial ovarian cancer. Ann. Surg. Oncol. 2015;22(4):1341–1348. doi:10.1245/s10434-014-4112-9.

 PubMed Web of Science ®Google Scholar

Tseng JH, Cowan RA, Afonso AM, Zhou Q, Iasonos A, Ali N, Thompson E, Sonoda Y, O’Cearbhaill RE, Chi DS, et al. Perioperative epidural use and survival outcomes in patients undergoing primary debulking surgery for advanced ovarian cancer. Gynecol Oncol. 2018;151(2):287–293. doi:10.1016/j.ygyno.2018.08.024.

 PubMed Web of Science ®Google Scholar

Capmas P, Billard V, Gouy S, Lhomme C, Pautier P, Morice P, Uzan C. Impact of epidural analgesia on survival in patients undergoing complete cytoreductive surgery for ovarian cancer. Anticancer Res. 2012;32:1537–1542.

 PubMed Web of Science ®Google Scholar

Zhang H, Yang L, Zhu X, Zhu M, Sun Z, Cata JP, Chen W, Miao C. Association between intraoperative intravenous lidocaine infusion and survival in patients undergoing pancreatectomy for pancreatic cancer: a retrospective study. Br J Anaesth. 2020;125(2):141–148. doi:10.1016/j.bja.2020.03.034.

 PubMed Web of Science ®Google Scholar

Chen W, Xu Y, Zhang Y, Lou W, Han X. Positive impact of intraoperative epidural ropivacaine infusion on oncologic outcomes in pancreatic cancer patients undergoing pancreatectomy: a retrospective cohort study. J Cancer. 2021;12(15):4513–4521. doi:10.7150/jca.57661.

 PubMed Web of Science ®Google Scholar

Lin KJ, Hsu FK, Shyr YM, Ni YW, Tsou MY, Chang KY. Effect of epidural analgesia on long-term outcomes after curative surgery for pancreatic cancer: a single-center cohort study in Taiwan. J Chin Med Assoc. 2022;85(1):124–128. doi:10.1097/JCMA.0000000000000615.

 PubMed Web of Science ®Google Scholar

Alexander A, Lehwald-Tywuschik N, Rehders A, Rabenalt S, Verde PE, Eisenberger CF, Picker N, Knoefel WT, Kienbaum P. Peridural Anesthesia and Cancer-Related Survival after Surgery for Pancreatic Cancer-A Retrospective Cohort Study. Clin pract. 2021;11(3):532–542. doi:10.3390/clinpract11030070.

 PubMed Web of Science ®Google Scholar

Wuethrich PY, Thalmann GN, Studer UE, Burkhard FC. Epidural analgesia during open radical prostatectomy does not improve long-term cancer-related outcome: a retrospective study in patients with advanced prostate cancer. PloS one. 2013;8(8):e72873. doi:10.1371/journal.pone.0072873.

 PubMed Web of Science ®Google Scholar

Biki B, Mascha E, Moriarty DC, Fitzpatrick JM, Sessler DI, Buggy DJ. Anesthetic technique for radical prostatectomy surgery affects cancer recurrence: a retrospective analysis. Anesthesiol. 2008;109(2):180–19. doi:10.1097/ALN.0b013e31817f5b73.

 PubMed Web of Science ®Google Scholar

Wuethrich PY, Hsu Schmitz SF, Kessler TM, Thalmann GN, Studer UE, Stueber F, Burkhard FC. Potential influence of the anesthetic technique used during open radical prostatectomy on prostate cancer-related outcome: a retrospective study. Anesthesiol. 2010;113(3):570–576. doi:10.1097/ALN.0b013e3181e4f6ec.

 PubMed Web of Science ®Google Scholar

Forget P, Tombal B, Scholtes JL, Nzimbala J, Meulders C, Legrand C, Van Cangh P, Cosyns JP, De Kock M. Do intraoperative analgesics influence oncological outcomes after radical prostatectomy for prostate cancer? Eur J Anaesthesiol. 2011;28(12):830–835. doi:10.1097/EJA.0b013e32834b7d9a.

 PubMed Web of Science ®Google Scholar

Tsui BC, Rashiq S, Schopflocher D, Murtha A, Broemling S, Pillay J, Finucane BT. Epidural anesthesia and cancer recurrence rates after radical prostatectomy. Can J Anaesth. 2010;57(2):107–112. doi:10.1007/s12630-009-9214-7.

 PubMed Web of Science ®Google Scholar

Wu HL, Tai YH, Lin SP, Yang SH, Tsou MY, Chang KY. Epidural analgesia does not impact recurrence or mortality in patients after rectal cancer resection. Sci Rep. 2021;11(1):913. doi:10.1038/s41598-020-79657-5.

 PubMed Web of Science ®Google Scholar

Pei L, Tan G, Wang L, Guo W, Xiao B, Gao X, Wang L, Li H, Xu Z, Zhang X, et al. Comparison of combined general-epidural anesthesia with general anesthesia effects on survival and cancer recurrence: a meta-analysis of retrospective and prospective studies. PloS one. 2014;9(12):e114667. doi:10.1371/journal.pone.0114667.

 PubMed Web of Science ®Google Scholar

Sun Y, Li T, Gan TJ. The effects of perioperative regional anesthesia and analgesia on cancer recurrence and survival after oncology surgery: a systematic review and meta-analysis. Reg Anesth Pain Med. 2015;40(5):589–598. doi:10.1097/AAP.0000000000000273.

 PubMed Web of Science ®Google Scholar

Weng M, Chen W, Hou W, Li L, Ding M, Miao C. The effect of neuraxial anesthesia on cancer recurrence and survival after cancer surgery: an updated meta-analysis. Oncotarget. 2016;7(12):15262–15273. doi:10.18632/oncotarget.7683.

 PubMedGoogle Scholar

Chen WK, Miao CH, Landoni G. The effect of anesthetic technique on survival in human cancers: a meta-analysis of retrospective and prospective studies. PloS one. 2013;8(2):e56540. doi:10.1371/journal.pone.0056540.

 PubMed Web of Science ®Google Scholar

Guerrero Orriach JL, Raigon Ponferrada A, Malo Manso A, Herrera Imbroda B, Escalona Belmonte JJ, Ramirez Aliaga M, Ramirez Fernandez A, Diaz Crespo J, Soriano Perez AM, Fontaneda Heredia A, et al. Anesthesia in combination with propofol increases disease-free survival in bladder cancer patients who undergo radical tumor cystectomy as compared to inhalational anesthetics and opiate-based analgesia. Oncology. 2020;98(3):161–167. doi:10.1159/000504807.

 PubMed Web of Science ®Google Scholar

Deegan CA, Murray D, Doran P, Ecimovic P, Moriarty DC, Buggy DJ. Effect of anaesthetic technique on oestrogen receptor-negative breast cancer cell function in vitro. Br J Anaesth. 2009;103(5):685–690. doi:10.1093/bja/aep261.

 PubMed Web of Science ®Google Scholar

Sultan SS. Paravertebral block can attenuate cytokine response when it replaces general anesthesia for cancer breast surgeries. Saudi J Anaesth. 2013;7(4):373–377. doi:10.4103/1658-354X.121043.

 PubMedGoogle Scholar

Karmakar MK, Samy W, Lee A, Li JW, Chan WC, Chen PP, Tsui BCH. Survival analysis of patients with breast cancer undergoing a modified radical mastectomy with or without a thoracic paravertebral block: a 5-Year follow-up of a randomized controlled trial. Anticancer Res. 2017;37(10):5813–5820. doi:10.21873/anticanres.12024.

 PubMed Web of Science ®Google Scholar

Finn DM, Ilfeld BM, Unkart JT, Madison SJ, Suresh PJ, Sandhu NPS, Kormylo NJ, Malhotra N, Loland VJ, Wallace MS, et al. Post-mastectomy cancer recurrence with and without a continuous paravertebral block in the immediate postoperative period: a prospective multi-year follow-up pilot study of a randomized, triple-masked, placebo-controlled investigation. Journal of Anesthesia. 2017;31(3):374–379. doi:10.1007/s00540-017-2345-z.

 PubMed Web of Science ®Google Scholar

Vanni G, Materazzo M, Perretta T, Meucci R, Anemona L, Buonomo C, Dauri M, Granai AV, Rho M, Ingallinella S, et al. Impact of awake breast cancer surgery on postoperative lymphocyte responses. vivo. 2019;33(6):1879–1884. doi:10.21873/invivo.11681.

 PubMed Web of Science ®Google Scholar

Badwe RA, Parmar V, Nair N, Joshi S, Hawaldar R, Pawar S, Kadayaprath G, Borthakur BB, Rao Thammineedi S, Pandya S, et al. Effect of peritumoral infiltration of local anesthetic before surgery on survival in early breast cancer. J Clin Oncol. 2023;41(18):3318–3328. doi:10.1200/JCO.22.01966.

 PubMed Web of Science ®Google Scholar

Sessler DI, Pei L, Huang Y, Fleischmann E, Marhofer P, Kurz A, Mayers DB, Meyer-Treschan TA, Grady M, Tan EY, et al. Recurrence of breast cancer after regional or general anaesthesia: a randomised controlled trial. Lancet. 2019;394(10211):1807–1815. doi:10.1016/S0140-6736(19)32313-X.

 PubMed Web of Science ®Google Scholar

Wang HL, Yan HD, Liu YY, Sun BZ, Huang R, Wang XS, Lei WF. Intraoperative intravenous lidocaine exerts a protective effect on cell-mediated immunity in patients undergoing radical hysterectomy. Mole Med Rep. 2015;12(5):7039–7044. doi:10.3892/mmr.2015.4235.

 PubMed Web of Science ®Google Scholar

Christopherson R, James KE, Tableman M, Marshall P, Johnson FE. Long-term survival after colon cancer surgery: a variation associated with choice of anesthesia. Anesth Analg. 2008;107(1):325–332. doi:10.1213/ane.0b013e3181770f55.

 PubMed Web of Science ®Google Scholar

Xu YJ, Chen WK, Zhu Y, Wang SL, Miao CH. Effect of thoracic epidural anaesthesia on serum vascular endothelial growth factor C and cytokines in patients undergoing anaesthesia and surgery for colon cancer. Br J Anaesth. 2014;113 Suppl 1:i49–55. doi:10.1093/bja/aeu148.

 PubMed Web of Science ®Google Scholar

MacFater WS, Xia W, Barazanchi AWH, MacFater HS, Lightfoot N, Svirskis D, Kahokehr AA, Hill AG. Association between perioperative intraperitoneal local anaesthetic infusion and long-term survival and cancer recurrence after colectomy: follow-up analysis of a previous randomized controlled trial. ANZ J Surg. 2020;90(5):802–806. doi:10.1111/ans.15753.

 PubMed Web of Science ®Google Scholar

Kim SY, Kim NK, Baik SH, Min BS, Hur H, Lee J, Noh HY, Lee JH, Koo BN. Effects of postoperative pain management on immune function after laparoscopic resection of colorectal cancer: a randomized study. Med. 2016;95(19):e3602. doi:10.1097/MD.0000000000003602.

 PubMed Web of Science ®Google Scholar

Falk W, Magnuson A, Eintrei C, Henningsson R, Myrelid P, Matthiessen P, Gupta A. Comparison between epidural and intravenous analgesia effects on disease-free survival after colorectal cancer surgery: a randomised multicentre controlled trial. Br J Anaesth. 2021;127(1):65–74. doi:10.1016/j.bja.2021.04.002.

 PubMed Web of Science ®Google Scholar

Ostovic H, Simac B, Prazetina M, Bradic N, Persec J. The effect of intravenous lidocaine, ketamine, and lidocaine-ketamine combination in colorectal cancer surgery: a randomized controlled trial. Anesth Analg. 2023. doi:10.1213/ANE.0000000000006555.

 PubMedGoogle Scholar

Alexa AL, Ciocan A, Zaharie F, Valean D, Sargarovschi S, Breazu C, Al Hajjar N, Ionescu D. The Influence of Intravenous Lidocaine Infusion on Postoperative Outcome and Neutrophil-to-Lymphocyte Ratio in Colorectal Cancer Patients. A Pilot Study. J. Gastrointest. Liver Dis. 2023;32(2):156–161. doi:10.15403/jgld-4962.

 PubMed Web of Science ®Google Scholar

Kochhar A, Banday J, Ahmad Z, Panjiar P, Vajifdar H. Cervical epidural analgesia combined with general anesthesia for head and neck cancer surgery: a randomized study. J Anaesthesiol Clin Pharmacol. 2020;36(2):182–186. doi:10.4103/joacp.JOACP_72_19.

 PubMed Web of Science ®Google Scholar

Wang L, Liang S, Chen H, Xu Y, Wang Y. The effects of epidural anaesthesia and analgesia on T lymphocytes differentiation markers and cytokines in patients after gastric cancer resection. BMC Anesthesiol. 2019;19(1):102. doi:10.1186/s12871-019-0778-7.

 PubMedGoogle Scholar

Wu YF, Li XP, Yu YB, Chen L, Jiang CB, Li DY, Chen ML. Postoperative local incision analgesia for acute pain treatment in patients with hepatocellular carcinoma. Rev. Assoc. Med. Bras. 2018;64(2):175–180. doi:10.1590/1806-9282.64.02.175.

 PubMed Web of Science ®Google Scholar

Sen Y, Xiyang H, Yu H. Effect of thoracic paraspinal block-propofol intravenous general anesthesia on VEGF and TGF-beta in patients receiving radical resection of lung cancer. Med. 2019;98(47):e18088. doi:10.1097/MD.0000000000018088.

 PubMed Web of Science ®Google Scholar

Xu D, Luo W. Effect of ropivacaine combined with small doses of triamcinolone and continuous nerve block of unilateral paravertebral canal guided by ultrasound on metastasis after radical treatment of lung cancer. J Oncol. 2022;2022:6310081. doi:10.1155/2022/6310081.

 PubMed Web of Science ®Google Scholar

Xu ZZ, Li HJ, Li MH, Huang SM, Li X, Liu QH, Li J, Li XY, Wang DX, Sessler DI. Epidural anesthesia-analgesia and recurrence-free survival after lung cancer surgery: a randomized trial. Anesthesiol. 2021;135(3):419–432. doi:10.1097/ALN.0000000000003873.

 PubMed Web of Science ®Google Scholar

Hayden J, Gupta A, Thorn SE, Thulin P, Block L, Oras J. Does intraperitoneal ropivacaine reduce postoperative inflammation? A prospective, double-blind, placebo-controlled pilot study. Acta anaesthesiologica Scandinavica. 2019;63(8):1048–1054. doi:10.1111/aas.13410.

 PubMed Web of Science ®Google Scholar

Hayden JM, Oras J, Block L, Thorn SE, Palmqvist C, Salehi S, Nordstrom JL, Gupta A. Intraperitoneal ropivacaine reduces time interval to initiation of chemotherapy after surgery for advanced ovarian cancer: randomised controlled double-blind pilot study. Br J Anaesth. 2020;124(5):562–570. doi:10.1016/j.bja.2020.01.026.

 PubMed Web of Science ®Google Scholar

Zhang H, Qu M, Guo K, Wang Y, Gu J, Wu H, Zhu X, Sun Z, Cata JP, Chen W, et al. Intraoperative lidocaine infusion in patients undergoing pancreatectomy for pancreatic cancer: a mechanistic, multicentre randomised clinical trial. Br J Anaesth. 2022;129(2):244–253. doi:10.1016/j.bja.2022.03.031.

 PubMed Web of Science ®Google Scholar

Myles PS, Peyton P, Silbert B, Hunt J, Rigg JR, Sessler DI, Investigators ATG. Perioperative epidural analgesia for major abdominal surgery for cancer and recurrence-free survival: randomised trial. BMJ. 2011;342(mar29 2):d1491. doi:10.1136/bmj.d1491.

 PubMedGoogle Scholar

Du YT, Li YW, Zhao BJ, Guo XY, Feng Y, Zuo MZ, Fu C, Zhou WJ, Li HJ, Liu YF, et al. Long-term survival after combined epidural-general anesthesia or general anesthesia alone: follow-up of a randomized trial. Anesthesiol. 2021;135(2):233–245. doi:10.1097/ALN.0000000000003835.

 PubMed Web of Science ®Google Scholar