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Donal J. Buggy - One of the best experts on this subject based on the ideXlab platform.

  • influence of perioperative anaesthetic and Analgesic interventions on oncological outcomes a narrative review
    BJA: British Journal of Anaesthesia, 2019
    Co-Authors: Tom Wall, Donal J. Buggy, Aislinn Sherwin
    Abstract:

    Summary Surgery is an important treatment modality for the majority of solid organ cancers. Unfortunately, cancer recurrence following surgery of curative intent is common, and typically results in refractory disease and patient death. Surgery and other perioperative interventions induce a biological state conducive to the survival and growth of residual cancer cells released from the primary tumour intraoperatively, which may influence the risk of a subsequent metastatic disease. Evidence is accumulating that anaesthetic and Analgesic interventions could affect many of these pathophysiological processes, influencing risk of cancer recurrence in either a beneficial or detrimental way. Much of this evidence is from experimental in vitro and in vivo models, with clinical evidence largely limited to retrospective observational studies or post hoc analysis of RCTs originally designed to evaluate non-cancer outcomes. This narrative review summarises the current state of evidence regarding the potential effect of perioperative anaesthetic and Analgesic interventions on cancer biology and clinical outcomes. Proving a causal link will require data from prospective RCTs with oncological outcomes as primary endpoints, a number of which will report in the coming years. Until then, there is insufficient evidence to recommend any particular anaesthetic or Analgesic Technique for patients undergoing tumour resection surgery on the basis that it might alter the risk of recurrence or metastasis.

  • Effect of Perioperative Lidocaine, Propofol and Steroids on Pulmonary Metastasis in a Murine Model of Breast Cancer Surgery
    MDPI AG, 2019
    Co-Authors: James Freeman, Peter D. Crowley, Andrew G. Foley, Helen C. Gallagher, Masae Iwasaki, Donal J. Buggy
    Abstract:

    Addressing the hypothesis that anaesthetic-Analgesic Technique during cancer surgery might influence recurrence or metastatic spread is a research priority. Propofol, which has anti-inflammatory properties in vitro, is clinically associated with reduced risk of cancer recurrence compared with sevoflurane anaesthesia in retrospective studies. Amide local anaesthetics, such as lidocaine, have cancer inhibiting effects in vitro. Steroids have anti-inflammatory and immunosuppressive effects and are associated with improved recovery after major non-cancer surgery. We compared the effects of propofol, lidocaine and methylprednisolone on postoperative metastasis in a murine model of breast cancer surgery under sevoflurane anaesthesia. 4T1 tumour cells were introduced into the mammary fat-pad of female BALB/c mice and the resulting tumour resected seven days later under general anaesthesia with sevoflurane. Mice (n = 72) were randomized to four treatment groups: Sevoflurane alone (control); Propofol group received 5 mg.kg−1; Lidocaine group received 1.5 mg.kg−1 followed by 2 mg.kg−1.h−1 infusion; Methylprednisolone group received 30 mg.kg−1 methylprednisolone. The primary outcome measure was pulmonary metastasis colony count, as assessed by in-vitro proliferation, two weeks post-operatively. This was achieved by treating the post-mortem lung tissue with collagenase IV, straining and culturing for 14 days prior to colony count. Compared with control, lidocaine and propofol each individually reduced pulmonary metastasis colonies; mean (SD) 846 (±581) vs. 88 (±52) vs. 34 (±44) respectively, (p = 0.0001 and p = 0.0001). Methylprednisolone increased lung metastasis, 2555 (±609) vs. 846 (±581), p = 0.0001. Post-operative hepatic metastatic disease and serum interleukin-6 and vascular endothelial growth factor levels were similar in all groups. In conclusion, in a murine model of breast cancer surgery during sevoflurane anaesthesia, propofol and lidocaine each decreased pulmonary metastasis, while methylprednisolone increased it

  • the effect of anaesthetic and Analgesic Technique on oncological outcomes
    Current Anesthesiology Reports, 2018
    Co-Authors: Aislinn Sherwin, Donal J. Buggy
    Abstract:

    The purpose of this review is to provide an examination of the recent literature relating to anaesthesia and analgesia for cancer surgery and their potential effects on cancer recurrence and metastasis. Opioids continue to have mixed results in terms of their long-term effects on cancer outcomes. While laboratory evidence suggests alterations in immune responses and pro-tumourigenic effects via opioid receptors on cancer cells, clinical evidence is lacking. Regional anaesthesia has the ability to regulate surgical stress response, but retrospective studies provide conflicting results. However, lidocaine appears to have protective functions against cancer and anti-inflammatory properties making it a potentially useful agent perioperatively. An association also exists between the use of non-steroidal anti-inflammatory agents and improved perioperative outcomes; however, prospective clinical studies are required to provide more robust data in this area. Inhalational agents appear to confer increased risk of cancer recurrence in comparison to total intravenous anaesthesia (TIVA). A recent large retrospective trial and in vivo and in vitro evidence point to a beneficial effect of TIVA versus volatiles that should be fully investigated. Retrospective analysis provides tenuous links between the Techniques used perioperatively and potential cancer recurrence and metastasis. In vitro and in vivo animal studies have furthered research in the area, particularly providing mechanisms on how commonly used agents can affect patient outcomes. However, large prospective randomised control trials are required in this area to further the research on anaesthesia and its effects on cancer recurrence and metastasis.

  • systematic review and consensus definitions for standardised endpoints in perioperative medicine postoperative cancer outcomes
    BJA: British Journal of Anaesthesia, 2018
    Co-Authors: Jim Freeman, M Z Johnson, Kate Leslie, Bernhard Riedel, A. Kurz, Donal J. Buggy, Daniel I Sessler, Vijaya Gottumukkala
    Abstract:

    BACKGROUND: The Standardising Endpoints for Perioperative Medicine group was established to derive an appropriate set of endpoints for use in clinical trials related to anaesthesia and perioperative medicine. Anaesthetic or Analgesic Technique during cancer surgery with curative intent may influence the risk of recurrence or metastasis. However, given the current equipoise in the existing literature, prospective, randomised, controlled trials are necessary to test this hypothesis. As such, a cancer subgroup was formed to derive endpoints related to research in onco-anaesthesia based on a current evidence base, international consensus and expert guidance. METHODS: We undertook a systematic review to identify measures of oncological outcome used in the oncological, surgical, and wider literature. A multiround Delphi consensus process that included up to 89 clinician-researchers was then used to refine a recommended list of endpoints. RESULTS: We identified 90 studies in a literature search, which were the basis for a preliminary list of nine outcome measures and their definitions. A further two were added during the Delphi process. Response rates for Delphi rounds one, two, and three were 88% (n=9), 82% (n=73), and 100% (n=10), respectively. A final list of 10 defined endpoints was refined and developed, of which six secured approval by ≥70% of the group: cancer health related quality of life, days alive and out of hospital at 90 days, time to tumour progression, disease-free survival, cancer-specific survival, and overall survival (and 5-yr overall survival). CONCLUSION: Standardised endpoints in clinical outcomes studies will support benchmarking and pooling (meta-analysis) of trials. It is therefore recommended that one or more of these consensus-derived endpoints should be considered for inclusion in clinical trials evaluating a causal effect of anaesthesia-analgesia Technique on oncological outcomes.

  • opioids and tumour metastasis does the choice of the anesthetic Analgesic Technique influence outcome after cancer surgery
    Current Opinion in Anesthesiology, 2016
    Co-Authors: Cara Connolly, Donal J. Buggy
    Abstract:

    Purpose of reviewCancer is now one of the leading causes of death worldwide, and excisional surgery is an essential treatment for the four most common adult cancers. Opioids remain the most commonly prescribed Analgesics in the perioperative period of cancer surgery, yet the question of whether opio

Anahi Perlas - One of the best experts on this subject based on the ideXlab platform.

  • the impact of Analgesic modality on early ambulation following total knee arthroplasty
    Regional Anesthesia and Pain Medicine, 2013
    Co-Authors: Anahi Perlas, K R Kirkham, Rajeev Billing, Cyrus Tse, Richard Brull, Rajeev Gandhi, Vincent W S Chan
    Abstract:

    Introduction Total knee arthroplasty is associated with moderate to severe pain, and effective analgesia is essential to facilitate postoperative recovery. This retrospective cohort study examined the Analgesic and rehabilitation outcomes associated with 48-hour continuous femoral nerve block, local infiltration analgesia, or local infiltration analgesia plus adductor canal nerve block. Methods Patients undergoing total knee arthroplasty under spinal anesthesia, during an 8-month period, were retrospectively assessed with a targeted review of 100 patients per group. Records of eligible patients were reviewed to identify the Analgesic Technique used and the primary outcome of distance walked on postoperative day 1. Secondary outcomes included ambulation on days 2 and 3, numeric rating scale pain scores, opioid consumption, and adverse effects and discharge disposition. Results Two hundred ninety-eight eligible patients were reviewed. Local infiltration analgesia and local infiltration plus adductor canal block were associated with longer distances walked on postoperative day 1 than continuous femoral nerve block (median values of 20, 30, and 0 m, respectively; P Conclusions Local infiltration analgesia was associated with improved early analgesia and ambulation. The addition of adductor canal nerve block was associated with further improvements in early ambulation and a higher incidence of home discharge.

  • Analgesic effect of interscalene block using low dose bupivacaine for outpatient arthroscopic shoulder surgery
    Regional Anesthesia and Pain Medicine, 1998
    Co-Authors: Adnan Alkaisy, G Mcguire, Vincent W S Chan, G Bruin, Philip Peng, A Miniaci, Anahi Perlas
    Abstract:

    Abstract Background and Objectives. Although interscalene brachial plexus block (ISBPB) is often used to provide anesthesia for arthroscopic shoulder surgery, its selective Analgesic effect, provided by low-dose local anesthetic, has not been studied. We hypothesized that ISBPB using a low volume and low concentration of bupivacaine can provide effective postoperative analgesia for shoulder surgery without producing significant sensory or motor block elsewhere. Methods. In this double-blind study, 30 outpatients scheduled to undergo shoulder arthroscopy were randomly assigned to receive either an ISBPB with 10 mL 0.125% bupivacaine with epinephrine 1:400,000 (n = 15) or 10 mL of normal saline (n = 15). The block was performed preoperative, prior to a standardized general anesthetic. Postoperative pain scores, morphine and oral Analgesic consumption, recovery profile, and patient satisfaction were recorded. Results. In the ISBPB group, verbal analog pain scores within 120 minutes after surgery were lower, morphine consumption in the postanesthesia care unit was significantly lower (2.7 ± 2.6 mg vs 9.5 ± 5.2 mg), the time to postoperative administration of the first systemic or oral Analgesic was significantly longer (141 ± 182 minutes vs 13 ± 10 minutes), the degree of motor and sensory block 120 minutes after surgery was minimal, time to reach hospital discharge criteria was earlier, and patient satisfaction with postoperative analgesia at 24-hour follow-up was greater. Thirty-three percent of the patients receiving ISBPB did not require any Analgesic prior to hospital discharge. Conclusions. Interscalene brachial plexus block with low-dose bupivacaine is a useful and selective Analgesic Technique for outpatient shoulder arthroscopic surgery.

Vincent W S Chan - One of the best experts on this subject based on the ideXlab platform.

  • the impact of Analgesic modality on early ambulation following total knee arthroplasty
    Regional Anesthesia and Pain Medicine, 2013
    Co-Authors: Anahi Perlas, K R Kirkham, Rajeev Billing, Cyrus Tse, Richard Brull, Rajeev Gandhi, Vincent W S Chan
    Abstract:

    Introduction Total knee arthroplasty is associated with moderate to severe pain, and effective analgesia is essential to facilitate postoperative recovery. This retrospective cohort study examined the Analgesic and rehabilitation outcomes associated with 48-hour continuous femoral nerve block, local infiltration analgesia, or local infiltration analgesia plus adductor canal nerve block. Methods Patients undergoing total knee arthroplasty under spinal anesthesia, during an 8-month period, were retrospectively assessed with a targeted review of 100 patients per group. Records of eligible patients were reviewed to identify the Analgesic Technique used and the primary outcome of distance walked on postoperative day 1. Secondary outcomes included ambulation on days 2 and 3, numeric rating scale pain scores, opioid consumption, and adverse effects and discharge disposition. Results Two hundred ninety-eight eligible patients were reviewed. Local infiltration analgesia and local infiltration plus adductor canal block were associated with longer distances walked on postoperative day 1 than continuous femoral nerve block (median values of 20, 30, and 0 m, respectively; P Conclusions Local infiltration analgesia was associated with improved early analgesia and ambulation. The addition of adductor canal nerve block was associated with further improvements in early ambulation and a higher incidence of home discharge.

  • Analgesic effect of interscalene block using low dose bupivacaine for outpatient arthroscopic shoulder surgery
    Regional Anesthesia and Pain Medicine, 1998
    Co-Authors: Adnan Alkaisy, G Mcguire, Vincent W S Chan, G Bruin, Philip Peng, A Miniaci, Anahi Perlas
    Abstract:

    Abstract Background and Objectives. Although interscalene brachial plexus block (ISBPB) is often used to provide anesthesia for arthroscopic shoulder surgery, its selective Analgesic effect, provided by low-dose local anesthetic, has not been studied. We hypothesized that ISBPB using a low volume and low concentration of bupivacaine can provide effective postoperative analgesia for shoulder surgery without producing significant sensory or motor block elsewhere. Methods. In this double-blind study, 30 outpatients scheduled to undergo shoulder arthroscopy were randomly assigned to receive either an ISBPB with 10 mL 0.125% bupivacaine with epinephrine 1:400,000 (n = 15) or 10 mL of normal saline (n = 15). The block was performed preoperative, prior to a standardized general anesthetic. Postoperative pain scores, morphine and oral Analgesic consumption, recovery profile, and patient satisfaction were recorded. Results. In the ISBPB group, verbal analog pain scores within 120 minutes after surgery were lower, morphine consumption in the postanesthesia care unit was significantly lower (2.7 ± 2.6 mg vs 9.5 ± 5.2 mg), the time to postoperative administration of the first systemic or oral Analgesic was significantly longer (141 ± 182 minutes vs 13 ± 10 minutes), the degree of motor and sensory block 120 minutes after surgery was minimal, time to reach hospital discharge criteria was earlier, and patient satisfaction with postoperative analgesia at 24-hour follow-up was greater. Thirty-three percent of the patients receiving ISBPB did not require any Analgesic prior to hospital discharge. Conclusions. Interscalene brachial plexus block with low-dose bupivacaine is a useful and selective Analgesic Technique for outpatient shoulder arthroscopic surgery.

Daniel B. Carr - One of the best experts on this subject based on the ideXlab platform.

  • Continuous Lumbar Plexus Block Provides Improved Analgesia With Fewer Side Effects Compared With Systemic Opioids After Hip Arthroplasty: A Randomized Controlled Trial
    Regional anesthesia and pain medicine, 2007
    Co-Authors: Zafar I. Siddiqui, M. Soledad Cepeda, William T. Denman, Roman Schumann, Daniel B. Carr
    Abstract:

    Background and Objectives: A single injection lumbar plexus block for acute pain management after hip surgery is usually limited to the immediate postoperative period. We conducted a randomized controlled trial to determine the effect of a continuous lumbar plexus block on perioperative opioid requirements and pain intensity. Methods: Adult patients undergoing elective hip arthroplasty under general anesthesia were randomized to continuous lumbar plexus block combined with patient-controlled analgesia (PCA) or PCA only for postoperative pain. Patients allocated to the lumbar plexus block had the catheter placed before surgery. Patients were followed for 36 hours. Perioperative opioid requirement was the primary outcome; secondary outcomes included assessment of pain intensity, patient and surgeon satisfaction with the Analgesic Technique, and occurrence of nausea and vomiting. Results: Seventeen patients were randomized to each treatment group. Compared with patients in the PCA group, patients in the continuous lumbar plexus block group required less morphine (12 mg) (95% CI, −12.9 to −3.9), had on average less pain (−2.1 units on a 0 to 10 scale) (95% CI, −3.8 to −1.1), were more satisfied with their Analgesic Technique, and experienced less nausea and vomiting. One patient in the continuous lumbar plexus block developed a delayed paresis and 1 patient in the PCA group developed respiratory depression. Conclusions: Continuous lumbar plexus block combined with PCA is superior to PCA alone for postoperative pain management following hip replacement. It reduces opioid requirements, opioid related side effects, and enhances patient satisfaction. However, additional research is required to determine its safety in light of the neurologic injury observed.

Mark Lewis - One of the best experts on this subject based on the ideXlab platform.