In a trial reported in The Lancet, Sessler et al found no difference in breast cancer recurrence after surgery with regional anesthesia-analgesia using paravertebral block and propofol vs general anesthesia with the volatile anesthetic sevoflurane and opioid analgesia. They also found no difference in persistent incisional pain between approaches.

As noted by the investigators, surgical stress response, use of volatile anesthetics, and use of opioids for analgesia are perioperative factors that can impair host defense against recurrence during cancer surgery; it was hypothesized that the potential impact of these factors would be reduced or eliminated with the use of regional anesthesia-analgesia. 

Study Details

In the trial, 2,108 women undergoing potentially curative primary breast cancer resection at 13 sites in Argentina, Austria, China, Germany, Ireland, New Zealand, Singapore, and the United States were randomly assigned between January 2007 and January 2018 to receive regional anesthesia-analgesia with paravertebral block and the anesthetic propofol (n = 1,043) or general anesthesia with sevoflurane and opioid analgesia (n = 1,065).

The primary outcome measure was local or metastatic breast cancer recurrence in the intent-to-treat population. A secondary outcome measure was incisional pain at 6 months and 12 months.

Recurrence and Incisional Pain

At second interim analysis, the predefined futility boundary was crossed, and the trial was stopped. Median follow-up was 36 months.

Recurrence was observed in 10% of the regional anesthesia-analgesia group vs 10% of the general anesthesia group (hazard ratio = 0.97; P = .84).

Incisional pain was reported by 52% of patients in the regional anesthesia-analgesia group vs 52% of patients in the general anesthesia group at 6 months, and by 28% vs 27% at 12 months (overall interim-adjusted odds ratio = 1.00; P = .99). No difference in neuropathic breast pain was observed between the two groups at 6 months (10% vs 10%) or 12 months (7% vs 7%).

The investigators concluded, “In our study population, regional anesthesia-analgesia (paravertebral block and propofol) did not reduce breast cancer recurrence after potentially curative surgery compared with volatile anesthesia (sevoflurane) and opioids. The frequency and severity of persistent incisional breast pain was unaffected by anesthetic technique. Clinicians can use regional or general anesthesia with respect to breast cancer recurrence and persistent incisional pain.”

Yuguang Huang, MD, of the Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, is the corresponding author for The Lancet article.

Disclosure: The study was funded by Sisk Healthcare Foundation (Ireland), Eccles Breast Cancer Research Fund, British Journal of Anaesthesia International, College of Anaesthetists of Ireland, Peking Union Medical College Hospital, Science Fund for Junior Faculty 2016, Central Bank of Austria, and National Healthcare Group. For full disclosures of the study authors, visit thelancet.com.