Impact of Local Anesthetics on Cancer Behavior and Outcome during the Perioperative Period: A Review

There is a growing interest regarding the impact of the perioperative period and the application of anesthetic drugs on the recurrence of cancer metastases. Among them, the use of amide-type local anesthetics seems promising since in vitro studies and animal models have shown their potential to inhibit the Intercellular Adhesion Molecule 1 (ICAM-1) expression and Src activity, which are clearly implicated in the process of inflammation and cancer metastases. This review emphasizes the potential of amide-type local anesthetics in this context. Keywords: cancer recurrence; local anesthetics; metastase

Non anesthetic action of local anesthetics

Local anesthetics are not only used as drugs to block the sodium channel to provide analgesi and anti-arrhythmic action. The purpose of this review is to highlight the new indications and limitations of this class of drugs. Recent research has focused on the use of i.v. local anesthetics to improve bowel function after surgery or trauma, to protect the central nervous system, to find new clues of local anesthetic effects in chronic neuropathic pain and to investigate the long-term effect of anesthesia / analgesia provided by local anesthetics on cancer recurrence. Recent facts dealing with myo- and chondrotoxicity are presented. There is growing evidence that local anesthetics have a broad spectrum of indications aside analgesia and anti-arrhythmic effect. Most of them are still insufficiently known and investigated. These new indications will no doubt be intensively studied in the coming years

Case report: Unusual complication during outpatient continuous regional popliteal analgesia

Purpose: Continuous regional anesthesia applied as pain therapy at home is clinically established standard practice after upper and lower limb surgery. Persistent motor block at discharge or after continuous infusion of local anesthetics, however, might lead to complications related to the insensate extremity. We report a rare case of a foot fracture due to stumbling after continuous sciatic nerve block at home and discuss the related clinical implications. Clinical features: After uncomplicated ambulatory foot surgery under regional anesthesia, a patient was discharged with a continuous sciatic popliteal nerve block for pain therapy at home. After stumbling, the patient remained symptom-free even until catheter removal three days after surgery. Radiography done one week after surgery revealed a styloid fracture of the fifth metatarsal bone. Her subsequent recovery was uneventful. Conclusions: The true incidence of complications related to falls at home associated with lower extremity blockade remains unknown, as symptoms of possible complications may be masked by the effects of the local anesthetic. However, with increasing use of postoperative regional anesthesia, it is mandatory to develop and adhere to clinical care maps, and to elaborate and teach strategies to further enhance patient safet

The Role of Continuous Peripheral Nerve Blocks

A continuous peripheral nerve block (cPNB) is provided in the hospital and ambulatory setting. The most common use of CPNBs is in the peri- and postoperative period but different indications have been described like the treatment of chronic pain such as cancer-induced pain, complex regional pain syndrome or phantom limb pain. The documented benefits strongly depend on the analgesia quality and include decreasing baseline/dynamic pain, reducing additional analgesic requirements, decrease of postoperative joint inflammation and inflammatory markers, sleep disturbances and opioid-related side effects, increase of patient satisfaction and ambulation/functioning improvement, an accelerated resumption of passive joint range-of-motion, reducing time until discharge readiness, decrease in blood loss/blood transfusions, potential reduction of the incidence of postsurgical chronic pain and reduction of costs. Evidence deriving from randomized controlled trials suggests that in some situations there are also prolonged benefits of regional anesthesia after catheter removal in addition to the immediate postoperative effects. Unfortunately, there are only few data demonstrating benefits after catheter removal and the evidence of medium- or long-term improvements in health-related quality of life measures is still lacking. This review will give an overview of the advantages and adverse effects of cPNBs