Anesthesia-Analgesia Combination for Prostate Cancer Surgery May Improve Outcomes

Patients who received lower levels of opioid painkillers due to use of neuraxial analgesia along with general anesthesia had lower levels of systematic progression and overall death than those who received general anesthesia alone.

Reducing the amount of opioid painkillers used during and after radical prostatectomy for adenocarcinoma may have long-term benefits for prostate cancer patients, according to new research from the Mayo Clinic. The study found that supplementing general anesthesia with neuraxial analgesia in prostate cancer patients during and after surgery, thereby diminishing the use of opioids, was associated with improved outcomes.

Although radical retropubic prostatectomy is an effective treatment for prostate cancer, cancerous tumors recur in approximately 25% of cases. The authors of the study, published online on December 16, 2013, in the British Journal of Anaesthesia, suggest that opioids, due to their immunosuppressive nature, may be partially to blame for cancer recurrence. To test this theory, they used the Mayo Clinic prostatectomy database to compare cancer recurrence, systematic cancer progression, cancer mortality, and all-cause mortality in patients who received anesthesia with neuraxial analgesia and those who received anesthesia alone. While small studies have reported conflicting results on the benefits of using both anesthesia and analgesia, this is the first large retrospective analysis of the treatment.

Patients who had undergone radical prostatectomy for adenocarcinoma from January 1991 to December 2005 were identified. Those who received general anesthesia with neuraxial analgesia (median follow-up of 8.6 years) were matched with those who received anesthesia only (median follow-up of 9.0 years) based on age, disease stage, and other factors. All opioids used during the procedure and for the first 24 to 48 hours afterwards were recorded.

Although opioid use was not completely eliminated, it was reduced in patients who received general anesthesia and neuraxial analgesia compared with the anesthesia-only group. After adjusting for comorbidities and other factors, use of general anesthesia alone was associated with an increased risk for systematic cancer progression and all-cause mortality. When compared with patients who received both anesthesia and neuraxial analgesia, those who were only given anesthesia had a hazard ratio of 2.81 for systematic progression and 1.32 for death. Rates for death caused by prostate cancer were also higher among patients who were given anesthesia alone, although this difference was not statistically significant.

Although their results indicate that the combination of anesthesia and analgesia may reduce the rate of tumor progression and improve survival rates, the authors of the study note that more research is needed to determine whether the combination improves outcomes.

“Although our results suggest the possibility of the beneficial effects of regional anaesthetic techniques in some oncological outcomes after prostatectomy, we caution that the results from an observational study, such as ours, can only be viewed as hypothesis-generating and need to be confirmed (or refuted) in future prospective, randomized trials,” they conclude.