Anesthetic technique and the cytokine and matrix metalloproteinase response to primary breast cancer surgery

  • C.A. D
  • D. M
  • P. D
 et al. 
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Abstract

Background: Breast cancer is the most common malignancy in women. Surgery remains the most effective treatment. Several perioperative factors, including the surgical stress response, many anesthetics and opioids, adversely affect immune function. Regional anesthesia-analgesia attenuates perioperative immunosuppression. We tested the hypothesis that patients who receive combined propofol/paravertebral anesthesia-analgesia (propofol/paravertebral) exhibited reduced levels of protumorigenic cytokines and matrix metalloproteinases (MMPs) and elevated levels of antitumorigenic cytokines compared with patients receiving sevoflurane anesthesia with opioid analgesia (sevoflurane/opioid). Methods: Primary breast cancer surgery patients were randomized to propofol/paravertebral (n = 15) or sevoflurane/opioid (n = 17) and preoperative and postoperative serum concentrations of 11 cytokines (interleukin 1beta [IL-1beta], IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12p70, IL-13, interferon gamma, and tumor necrosis factor alpha) and 3 MMPs (MMP-1, MMP-3, and MMP-9) were measured. Results: Treatment groups were well balanced for age, weight, surgical procedure, and cancer pathologic diagnosis. Pain scores were lower at 1 and 2 hrs with paravertebral analgesia compared with morphine but similar at 24 hrs. Patients in the propofol/paravertebral group showed a greater percentage decrease in postoperative compared with preoperative IL-1beta (median [quartiles],-26% [-15% to-52%] versus-4% [-14% to 2%], P = 0.003), a significant attenuation in elevated MMP-3 (2% [-39% to 12%] versus 29% [23%-59%], P = 0.011) and MMP-9 (26% [13%-54%] versus 74% [50%-108%], P = 0.02), and a significant increase in IL-10 (10% [5%-33%] versus-15% [20% to-2%], P = 0.001) compared with sevoflurane/opioid group. No significantly different changes in IL-2, IL-4, IL-5, IL-6, IL-8, IL-12p70, IL-13, interferon gamma, tumor necrosis factor alpha, or MMP-1 were observed between the 2 groups. Conclusions: Propofol/paravertebral anesthesia-analgesia for breast cancer surgery alters a minority of cytokines influential in regulating perioperative cancer immunity. Further evaluation is required to determine the significance of these observations. Copyright © 2010 by American Society of Regional Anesthesia and Pain Medicine.

Author-supplied keywords

  • *anesthesiological techniques
  • *anesthetic agent
  • *breast cancer
  • *breast cancer/su [Surgery]
  • *cancer surgery
  • *cytokine
  • *fentanyl/cb [Drug Combination]
  • *fentanyl/cm [Drug Comparison]
  • *fentanyl/ct [Clinical Trial]
  • *levobupivacaine/cb [Drug Combination]
  • *levobupivacaine/cm [Drug Comparison]
  • *levobupivacaine/ct [Clinical Trial]
  • *matrix metalloproteinase
  • *morphine/cb [Drug Combination]
  • *morphine/cm [Drug Comparison]
  • *morphine/ct [Clinical Trial]
  • *morphine/im [Intramuscular Drug Administration]
  • *morphine/iv [Intravenous Drug Administration]
  • *propofol/cb [Drug Combination]
  • *propofol/cm [Drug Comparison]
  • *propofol/ct [Clinical Trial]
  • *sevoflurane/cb [Drug Combination]
  • *sevoflurane/cm [Drug Comparison]
  • *sevoflurane/ct [Clinical Trial]
  • *sevoflurane/ih [Inhalational Drug Administration]
  • adult
  • aged
  • analgesia
  • anesthesia
  • article
  • attenuation
  • blood level
  • clinical article
  • clinical trial
  • continuous infusion
  • controlled clinical trial
  • controlled study
  • diagnosis
  • diprifusor
  • female
  • gamma interferon
  • gamma interferon/ec [Endogenous Compound]
  • gelatinase B
  • gelatinase B/ec [Endogenous Compound]
  • human
  • hypothesis
  • immunosuppressive treatment
  • interleukin 10
  • interleukin 10/ec [Endogenous Compound]
  • interleukin 12p70
  • interleukin 12p70/ec [Endogenous Compound]
  • interleukin 13/ec [Endogenous Compound]
  • interleukin 1beta
  • interleukin 1beta/ec [Endogenous Compound]
  • interleukin 2
  • interleukin 2/ec [Endogenous Compound]
  • interleukin 4
  • interleukin 4/ec [Endogenous Compound]
  • interleukin 5
  • interleukin 5/ec [Endogenous Compound]
  • interleukin 6
  • interleukin 6/ec [Endogenous Compound]
  • interleukin 8
  • interleukin 8/ec [Endogenous Compound]
  • interstitial collagenase
  • interstitial collagenase/ec [Endogenous Compound]
  • leukocyte count
  • mastectomy
  • morphine
  • neoplasm
  • nitrogen 15
  • opiate
  • pain
  • pain assessment
  • paracetamol/iv [Intravenous Drug Administration]
  • paravertebral anesthesia
  • patient
  • postoperative period
  • preoperative period
  • priority journal
  • randomized controlled trial
  • regional anesthesia
  • sevoflurane
  • stress
  • stromelysin
  • stromelysin/ec [Endogenous Compound]
  • surgery
  • surgical patient
  • surgical stress
  • surgical technique
  • tumor immunity
  • tumor necrosis factor alpha XT - fentanyl / drug
  • tumor necrosis factor alpha/ec [Endogenous Compoun
  • unclassified drug
  • visual analog scale
  • weight

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Authors

  • Deegan C.A.

  • Murray D.

  • Doran P.

  • Moriarty D.C.

  • Sessler D.I.

  • Mascha E.

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