Anesthesia For Breast Cancer Surgery Research Articles

Regional anesthesia for breast cancer surgery: which block is best? A review of the current literature.

Breast cancer is the most common type of cancer worldwide. Fortunately, continual advances in diagnosis and treatment are resulting in increased survival rates. Earlier detection and treatment, to include surgical resection, can greatly improve patientsoutcomes. However, due to the complex innervation of the breast, management of postoperative pain has proven difficult in the past. Approximately, half of all women who undergo breast cancer surgery report postoperative pain syndrome. The paravertebral blockhas long been the anesthesiologist's choice for mitigating pain during and after the procedure. Newer techniques such as the pectoral nerve blockand erector spinae plane block may prove to have some additional benefits. This literature review compares the risks, benefitsand specific uses of these three regional nerve blocks in women undergoing breast cancer surgery. It aims to better inform anesthesiologistswhen they are choosing which technique is best for their patients.

Regional analgesia with or without general anaesthesia for breast cancer surgery: a network meta-analysis

Regional analgesia with or without general anaesthesia for breast cancer surgery: a network meta-analysis

A French nationwide survey on the practice of regional anesthesia for breast cancer surgery

The aim of this study was to assess the impact of recent recommendations concerning regional anesthesia for breast cancer surgery, a nationwide practice survey was carried out. This cross-sectional electronic survey, conducted in 2021, collected answers from a panel of anesthetists currently working in French practicing centers. It addressed the sets of techniques they practiced for every type of surgical procedure and their perceptions of the difficulties and risks associated with these techniques. The practice of regional anesthesia was generally high (70%), involving all the current types of blocks. Surgeon-done infiltration was popular for lumpectomy only. For the other current procedures, the pectoralis nerve blocks were preferred to the paravertebral block, which was favored for mastectomies, when a lymph node harvesting was planned, or for immediate or delayed pedicle flap. Catheters were mostly used for mastectomies with pedicle flap. The erector spinae plane block was emergent. Whatever the type of block, regional anesthesia was preferentially started before surgery. Despite some deviations such as the adjunction of unlabeled molecules, the practice fitted well with the European recommendations, but training and within-center guidance lacked standardization. For each block, actual practice, perceived difficulty, and risk were inter-correlated, but paravertebral block - either practiced or not - was considered as more difficult and riskier to perform than any other. These encouraging results do not dispense with the need to improve anesthetic practices both in quantity and quality. Such improvement in the anatomic fit to the procedure and in the timing of blocks will also have to be considered.

Effect of hypnosis before general anesthesia on postoperative outcomes in patients undergoing minor surgery for breast cancer: a systematic review and meta-analysis.

Preoperative anxiety is a common phenomenon in breast cancer, causing pain and tension, which is not conducive to the effective surgical treatment and postoperative recovery. It is believed that hypnosis can change the patient's perception of pain, thereby improving the patient's ability to control pain. However, the results of studies for this topic were controversy. In order to explore the effect of hypnosis in breast cancer surgery we included randomized controlled trials (RCTs) and conducted a meta analysis. PubMed, Web of Science, Wiley online library, Elsevier, and Clinicaltrials.gov databases were searched by computer with the keywords "hypnosis/hypnotherapy" and "breast cancer" and "oncologic surgery/surgery/biopsy". After screening, the meta-analysis was performed using RevMan 5.4 software, and the evidence was rated using GRADE profiler 3.6 software. A total of 1,242 patients were included in 8 studies, including 630 patients who received preoperative hypnosis and 612 patients who did not receive hypnosis. Meta-analysis showed that hypnosis before general anesthesia reduced the degree of preoperative anxiety (MD =-2.79, 95% CI: -3.93, -1.65, P<0.00001) and postoperative pain (MD =-1.25, 95% CI: -1.64, -0.86, P<0.00001) in patients undergoing breast cancer surgery, but had no effect on the operation time (MD =-6.30, 95% CI: -15.38, 2.78, P=0.17) and the incidence of postoperative nausea and vomiting (OR =0.68, 95% CI: 0.22, 2.07, P=0.49). The application of hypnosis before general anesthesia for breast cancer surgery can reduce the degree of anxiety of patients, also reducing postoperative pain.

Thoracic Spinal Anaesthesia for Modified Radical Mastectomy (MRM)

Background: Breast cancer mostly affects patients older than 65 years old. Geriatric patients may have comorbidities so the selection of anaesthesia for breast cancer surgery is challenging. In the past decade, thoracic spinal anaesthesia as regional anaesthesia was feasibly performed for laparoscopic cholecystectomy and minor breast surgery. This article aims to evaluate thoracal spinal anaesthesia for Modified Radical Mastectomy (MRM) in our hospital settings. Case: Three cases of Thoracal Spinal Anaesthesia were carried out for MRM surgery after neoadjuvant chemotherapy treatment. This procedure consists of removal of breast tissue and the ipsilateral axillary contents. The comorbidities include hypertension, cardiomegaly, and mild anaemia. There was no conversion to general anaesthesia during surgery until completion. Duration for surgery less than 120 minutes. No significant hemodynamic instability and complaint were found during intra and postoperative. Conclusion: From these cases, thoracal spinal anaesthesia was acceptable as regional anaesthesia for MRM in geriatric patient.

Segmental thoracic spinal anesthesia versus general anesthesia for breast cancer surgery: A prospective randomized-controlled open-label trial.

Breast surgery is associated with moderate-to-severe postoperative pain, nausea, and vomiting. For this, neuraxial anesthesia might be a better alternative to general anesthesia (GA), providing superior analgesia, with higher patient satisfaction and lesser incidence of nausea vomiting. This randomized-controlled open-label trial was done to compare segmental spinal and GA for breast cancer surgery. The present study enrolled 56 female patients scheduled to undergo breast cancer surgery. They were randomly divided into two groups, group G (received standard GA) and group TS (received segmental thoracic spinal anesthesia with 0.5% isobaric levobupi vacaine at T5-T6 inter spaces). The primary objective of this study was patient satisfaction with the anesthetic technique, while secondary objectives were hemodynamic changes, perioperative complications, time of first rescue analgesic, total opioid consumption in first 24 h, and surgeon satisfaction score. Data were expressed as mean (SD) or number (%) as indicated and were compared using Chi-square, Fisher's exact, or Student's ttest as appropriate. Patient in group TS had significantly higher satisfaction score median 5 (IQR 1) compared to patients in group G median 4 (IQR 3.5) (P = 0.0001). Nausea and vomiting were significantly higher in group G compared to group TS (P = 0.01). Mean time to rescue analgesia was 33.21 ± 7.48 min in group G as compared to 338.57 ± 40.70 in group TS and opioid consumption was also significantly lower in group TS (70.00 ± 27.38) as compared to group G (366.07 ± 59.40). There was no significant difference in hemodynamic parameters (except significantly lower heart rate at 15 min in group TS (P = 0.001) and surgeon satisfaction score between groups. Quality of postoperative analgesia was better in group TS. Segmental thoracic spinal anesthesia technique provides better satisfaction with superior postoperative analgesia and fewer complications in patients undergoing breast cancer surgery compared to GA.

Opioid-free anesthesia versus opioid-inclusive anesthesia for breast cancer surgery: a retrospective study

BackgroundBreast cancer surgery is usually managed using opioid-inclusive anesthesia (OIA), although opioids are associated with several adverse events, including nausea, vomiting, and constipation. Multimodal opioid-free anesthesia (OFA) has been introduced to reduce the incidence of these side effects. In this single-center retrospective study, we investigated whether ketamine, combined with magnesium and clonidine, could effectively control postoperative pain in patients undergoing quadrantectomy, while reducing postoperative nausea and vomiting (PONV).ResultsA total of 89 patients submitted to quadrantectomy were included and divided into an OFA group (38 patients) and an OIA group (51 patients) according to the received anesthetic technique. Analgesia in the OIA group was based on an intraoperative infusion of remifentanil, and analgesia in the OFA consisted of an intraoperative infusion of ketamine and magnesium sulfate. Postoperative pain in both groups was managed with nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol. Postoperative pain, assessed with the numeric rating scale (NRS), requirements for additional analgesics, the incidence of PONV, and patient satisfaction evaluated using a QoR-40 questionnaire were compared between the two groups. Levels of pain at 30 min and 6, 12, and 24 h after surgery; number of paracetamol rescue doses; and the incidence of PONV were lower in the OFA group (p <0.05). Patient satisfaction was comparable in the two groups.ConclusionsA combination of ketamine, magnesium, and clonidine could be more effective than opioid-based analgesia in reducing postoperative pain and lowering PONV occurrence after quadrantectomy for breast cancer.

Opioid-free anesthesia for breast cancer surgery: A comparison of ultrasound guided paravertebral and pectoral nerve blocks. A randomized controlled trial.

Background and Aims:Pectoral block (PECS)-based anesthesia without opioids decreases analgesic requirement, pain scores and post-operative nausea vomiting (PONV) compared to conventional opioid-based general anesthesia in patients undergoing modified radical mastectomy and axillary dissection (MRM-AD). We compared PECS versus Paravertebral Block (PVB) in providing an opioid free, nerve block-based regimen. Outcomes of interest were post-operative analgesic requirement, duration of analgesia, PONV and patient and surgeon satisfaction.Material and Methods:This randomised controlled study involved 58 adult ASA I-III patients posted for MRM-AD. After randomization patients were induced with propofol and maintained on spontaneous ventilation with isoflurane (0.8-1.0 MAC) through i-gel. Ultrasound-guided PECS or PV blocks (30 ml of 0.1% lignocaine + 0.25% bupivacaine + 1 μg/kg dexmedetomidine) were administered. Post-operative pain scores, non-opioid analgesic requirement over 24 hours, PONV, satisfaction of surgeon and patient were measured.Results:Between the two groups, there was no difference in demographics, ASA status, location and volume of breast tumour excised or the duration of surgery. The time from block to incision was significantly longer in the PV group (P = 0.01). There was no difference between the two groups in terms of intra and post-operative parameters, and the median VAS scores for pain at rest or during shoulder abduction were similarly low in both the groups.Conclusion:Both blocks result in equally prolonged analgesia and preclude requirement of opioid analgesics intra and post-operatively. PECS block is associated with lesser time to allow incision. Complications are low in both the groups. Routine use of these blocks to avoid opioids may be studied further.

Is COMBIPECS the answer to perioperative analgesia for breast surgery? A double blinded randomized controlled trial.

Background and Aims:Pecs block and its variations provides perioperative analgesia, reduce PONV and other opioid related side effects. We hypothesized that COMIBPES block in addition to general anaesthesia will provide better postoperative analgesia when compared to general anaesthesia alone in breast cancer surgery patients.Methods:After obtaining permission from the institutional review board and registering the trial with Clinical Trials Registry of India (CTRI), we conducted a double blinded randomized controlled trial of 100 patients posted for elective breast surgery with axillary dissection. Patients were divided into two groups, P (Pecs block) and C (control). Intraoperative analgesia, postoperative analgesia, postoperative nausea vomiting (PONV) and shoulder mobility on first postoperative day (POD1) were noted. Primary outcomes were the pain scores measured by visual analog scale (VAS) and cumulative intravenous morphine consumption from patient controlled analgesia (PCA) pump at measurement intervals of 0, 1, 4, 8, 12 and 24 hours postoperatively.Results:Intraoperatively, Group P patients did not require any additional analgesia, whereas all the patients in Group C required additional intraoperative morphine (mean, SD: 5.12, 2.63 mg, compared to nil in group P, P< 0.01). COMBIPECS block group had lower pain scores and PCA morphine requirements, less PONV and better shoulder mobility on POD1.Conclusion:COMBIPECS block is a valuable addition to general anaesthesia for breast cancer surgery as it reduces pain and PONV while allowing better postoperative shoulder mobility.

The effect of propofol and sevoflurane on cancer cell, natural killer cell, and cytotoxic T lymphocyte function in patients undergoing breast cancer surgery: an in vitro analysis

BackgroundTo clarify the effect of anaesthetic agents on cancer immunity, we evaluated the effects of propofol and sevoflurane on natural killer (NK) cell, cytotoxic T lymphocyte (CTL) counts and apoptosis rate in breast cancer and immune cells co-cultures from patients who underwent breast cancer surgery.MethodsVenous blood samples were collected after inducing anaesthesia and at 1 and 24 h postoperatively in patients who had undergone breast cancer surgery. The patients were allocated randomly to the propofol- or sevoflurane-based anaesthesia groups. We counted and detected apoptosis in cancer cell, NK cell and CTL of patients with breast cancer by co-culture with a breast cancer cell line in both groups. We also evaluated changes in the cytokines tumour necrosis factor-alpha, interleukin (IL)-6 and IL-10 during the perioperative period.ResultsForty-four patients were included in the final analysis. No difference in NK cell count, CTL count or apoptosis rate was detected between the groups. Furthermore, the number of breast cancer cells undergoing apoptosis in the breast cancer cell co-cultures was not different between the groups. No changes in cytokines were detected between the groups.ConclusionAlthough basic science studies have suggested the potential benefits of propofol over a volatile agent during cancer surgery, propofol was not superior to sevoflurane, on the aspects of NK and CTL cells counts with apoptosis rate including breast cancer cell, during anaesthesia for breast cancer surgery in a clinical environment.Trial registrationNCT02758249 on February 26, 2016.

Opioid-free anesthesia for breast cancer surgery: An observational study.

Background and Aims:Opioids are associated with postoperative nausea, vomiting, drowsiness, and increased analgesic requirement. A nonopioid anesthesia technique may reduce morbidity, enable day care surgery, and possibly decrease tumor recurrence. We compared opioid-free, nerve block-based anesthesia with opioid-based general anesthesia for breast cancer surgery in a prospective cohort study.Material and Methods:Twenty four adult American Society of Anesthesiologists grade I–III patients posted for modified radical mastectomy (MRM) with axillary dissection were induced with propofol and maintained on isoflurane (0.8–1.0 minimum alveolar concentration) through i-gel on spontaneous ventilation and administered ultrasound-guided PECS 1 and 2 blocks (0.1% lignocaine + 0.25% bupivacaine + 1 mcg/kg dexmedetomidine, 30 ml). Postoperative nausea, pain scores, nonopioid analgesic requirement over 24 h, stay in the recovery room, and satisfaction of surgeon and patient were studied. Twenty-four patients who underwent MRM and axillary dissection without a nerve block under routine opioid anesthesia with controlled ventilation were the controls.Results:MRM and axillary dissection under the nonopioid technique was adequate in all patients. Time in the recovery room, postoperative nausea, analgesic requirement, and visual analog scale scores were all significantly less in the nonopioid group. Surgeon and patient were satisfied with good patient quality of life on day 7.Conclusion:Nonopioid nerve block technique is adequate and safe for MRM with axillary clearance. Compared to conventional technique, it offers lesser morbidity and may allow for earlier discharge. Larger studies are needed to assess the long-term impact on chronic pain and tumor recurrence by nonopioid techniques.

Feasibility of Cervical Epidural Anesthesia for Breast Cancer Surgery

Background Effects of perioperative cervical level neuraxial blocks on the dissemination of cancer metastases have become a matter of substantial interest. However, experience with these catheters has been limited and data on feasibility and efficacy is sparse. Methods Data from 39 patients scheduled to undergo breast cancer surgery while awake with a cervical epidural alone was retrospectively analyzed. Results In 26 patients (66,7%, 95% CI 51,7–81,7) the cervical epidural catheter was sufficient for surgery. In one patient (2.6%, 95% CI 0–7.6) identification of the epidural space was not possible. Four patients (10.3%, 95% CI 0,7–19,9) had an insufficient sensory block. Seven patients (17.9%, 95% CI 5,7–30,1) had a partially insufficient sensory block. Rates of failed epidural blocks were not significantly different between different insertion levels. 21 patients (80.8%, 95% CI 65,4–96,1) developed hypotension and required an intravenous vasopressor. One patient developed nausea. In one patient the dura was accidentally punctured. No neurological damage was observed. No other major complications were observed. Discussion Epidural punctures in the cervical region are feasible but do bear potential for major complications. Anesthesiologists should familiarize themselves with high epidural block techniques.

Pectoral nerve block combined with general anesthesia for breast cancer surgery: a retrospective comparison.

BackgroundAcute postoperative pain is an integral risk factor in the development of chronic pain after breast cancer surgery (BCS). Pectoral nerve block (PECSB) has been recently reported as an analgesic method for BCS. Here, we retrospectively compared intraoperative opioid requirement, postoperative pain after BCS, and incidence of postoperative nausea and vomiting (PONV) in patients who underwent BCS under total intravenous anesthesia (TIVA) with or without PECSB.FindingsWe reviewed anesthesia charts and medical records of 146 patients who underwent BCS at Niigata University Medical and Dental Hospital from January 2013 to March 2014; 36 patients were included in the TIVA group, and 35 patients were included in the TIVA + PECSB group. Intraoperative remifentanil requirements were significantly lower in the TIVA + PECSB group than in the TIVA group, and the cumulative distribution of remifentanil was reduced in patients who received PECSB (TIVA: 10.9 ± 2.9 μg/kg/h; TIVA + PECSB: 7.3 ± 3.3 μg/kg/h; p < 0.001). Postoperative pain scores during the 48 h after surgery were significantly lower in the TIVA + PECSB group than in the TIVA group (TIVA: 2 [1–5]; TIVA + PECSB: 1 [0–5]; p = 0.03). However, administration of fentanyl during operation, percentage of patients requiring supplemental analgesics, and incidence of PONV were not significantly different between groups.ConclusionsPECSB significantly reduced intraoperative remifentanil usage and postoperative pain. However, the requirement for postoperative supplemental analgesics and the incidence of PONV did not differ. These data suggested that PECSB may be useful for perioperative pain management in patients undergoing BCS.

Effect of Propofol and Desflurane on Immune Cell Populations in Breast Cancer Patients: A Randomized Trial

Several factors can affect the perioperative immune function. We evaluated the effect of propofol and desflurane anesthesia on the surgery-induced immune perturbation in patients undergoing breast cancer surgery. The patients were randomly assigned to receive propofol (n = 20) or desflurane (n = 20) anesthesia. The total and differential white blood cell counts were determined with lymphocyte subpopulations before and 1 hr after anesthesia induction and at 24 hr postoperatively. Plasma concentrations of interleukin (IL)-2 and IL-4 were also measured. Both propofol and desflurane anesthesia preserved the IL-2/IL-4 and CD4(+)/CD8(+) T cell ratio. Leukocytes were lower in the propofol group than in the desflurane group at 1 hr after induction (median [quartiles], 4.98 [3.87-6.31] vs. 5.84 [5.18-7.94] 10(3)/µL) and 24 hr postoperatively (6.92 [5.54-6.86] vs. 7.62 [6.22-9.21] 10(3)/µL). NK cells significantly decreased 1 hr after induction in the propofol group (0.41 [0.34-0.53] to 0.25 [0.21-0.33] 10(3)/µL), but not in the desflurane group (0.33 [0.29-0.48] to 0.38 [0.30-0.56] 10(3)/µL). Our findings indicate that both propofol and desflurane anesthesia for breast cancer surgery induce a favorable immune response in terms of preservation of IL-2/IL-4 and CD4(+)/CD8(+) T cell ratio in the perioperative period. With respect to leukocytes and NK cells, desflurane anesthesia is associated with less adverse immune responses than propofol anesthesia during surgery for breast cancer. (Clinical trial registration at https://cris.nih.go.kr/cris number: KCT0000939).

Does anesthesia type influence breast cancer outcomes?

66 Background: Surgery maintains a central role in the local treatment of Stage 0-III breast cancer. Recent studies suggest patient immunity is altered by general anesthesia (GA), potentially worsening cancer outcomes. A single retrospective case review has concluded that breast cancer patients receiving regional anesthesia with paravertebral block (PVB) anesthesia had better cancer outcomes compared to patients receiving GA, but these conclusions have not been validated. We hypothesized that local regional anesthesia (LRA) would be associated with better cancer outcomes compared to GA. Methods: We performed a retrospective review of Stage 0-III breast cancer patients undergoing surgery in a single center during a nine year period ending 1/1/2010. Patients undergoing neoadjuvant therapy or major flap reconstruction were excluded. Data regarding patient, tumor and treatment factors known to influence cancer outcomes were collected. Overall survival (OS), disease free survival (DFS), local regional recurrence (LRR), and ipsilateral breast tumor recurrence (IBTR) were calculated by Kaplan-Meier method with Log-Rank comparison. Results: We analyzed 1,107 patients. Median age was 64 years (range 24-97). Median and longest follow-up were 5.5 and 12.5 years. GA was utilized for 461 (42%) patients, and 646 (58%) received LRA. Initial operation was breast conserving in 796 (72%) and mastectomy in 311 (28%). Forty two patients died from breast cancer (crude mortality 3.8%). LRR occurred in 34 patients (3%). LRA was used more than GA in patients with lower grade and stage, smaller tumors, positive hormone receptor status, and negative nodal status (p&lt;0.001). We identified no differences in OS, DFS, LRR or IBTR in comparison of GA to LRA. Conclusions: Type of anesthesia for breast cancer surgery did not affect cancer outcomes in our institution. This result differs from the only prior published clinical report on this topic.

General anesthesia for breast cancer surgery during pregnancy: a retrospective review at a breast cancer center in Tokyo between 1999 - 2011

General anesthesia for breast cancer surgery during pregnancy: a retrospective review at a breast cancer center in Tokyo between 1999 - 2011

Segmental thoracic spinal has advantages over general anesthesia for breast cancer surgery.

Background:Thoracic spinal anesthesia has been used for laparoscopic cholecystectomy and abdominal surgeries, but not in breast surgery. The present study compared this technique with general anesthesia in breast cancer surgeries.Materials and Methods:Forty patients were enrolled in this comparative study with inclusion criteria of ASA physical status I-III, primary breast cancer without known extension beyond the breast and axillary nodes, scheduled for unilateral mastectomy with axillary dissection. They were randomly divided into two groups. The thoracic spinal group (S) (n = 20) underwent segmental thoracic spinal anesthesia with bupivacaine and fentanyl at T5-T6 interspace, while the other group (n = 20) underwent general anesthesia (G). Intraoperative hemodynamic parameters, intraoperative complications, postoperative discharge time from post-anesthesia care unit (PACU), postoperative pain and analgesic consumption, postoperative adverse effects, and patient satisfaction with the anesthetic techniques were recorded.Results:Intraoperative hypertension (20%) was more frequent in group (G), while hypotension and bradycardia (15%) were more frequent in the segmental thoracic spinal (S) group. Postoperative nausea (30%) and vomiting (40%) during PACU stay were more frequent in the (G) group. Postoperative discharge time from PACU was shorter in the (S) group (124 ± 38 min) than in the (G) group (212 ± 46 min). The quality of postoperative analgesia and analgesic consumption was better in the (S) group. Patient satisfaction was similar in both groups.Conclusions:Segmental thoracic spinal anesthesia has some advantages when compared with general anesthesia and can be considered as a sole anesthetic in breast cancer surgery with axillary lymph node clearance.

Paravertebral Block Anesthesia for Breast Cancer Surgery

Paravertebral Block Anesthesia for Breast Cancer Surgery

Double-blinded, Placebo-controlled, Prospective Randomized Trial Evaluating the Efficacy of Paravertebral Block with and Without Continuous Paravertebral Block Analgesia in Outpatient Breast Cancer Surgery

Paravertebral block (PVB) is an effective alternative to general anesthesia for breast cancer surgery. Continuous paravertebral block (CPVB) anesthesia may extend postoperative analgesia at home and improve quality of early postoperative recovery of breast cancer patients. This double-blinded randomized trial was conducted to compare degree of pain, nausea, mood, level of symptom distress, and time to return to normal daily activity between PVB and PVB + CPVB in patients undergoing outpatient breast cancer surgery. Between July 2003 and April 2008 we randomly assigned 94 (73 evaluable) patients in a 1:1:1 ratio with early breast cancer to single injection PVB followed by CPVB infusion of 0.1% or 0.2% ropivacaine vs placebo (saline) for 48 hours postoperatively for unilateral breast cancer surgery without reconstruction. The primary study endpoint was the degree of pain, nausea, mood state, level of symptom distress, and recovery time. Of the 468 patients assessed for eligibility, 94 consented and 21 with incomplete data or follow-up were excluded, leaving 73 subjects for analysis. There was no clinically significant difference in degree of postoperative pain, nausea, mood state, level of symptom distress, or return to normal activity among the three study groups. The current study does not support the routine use of continuous paravertebral catheter anesthesia in patients undergoing operative treatment for breast cancer.

Effect of anaesthetic technique on oestrogen receptor-negative breast cancer cell function in vitro

Metastatic recurrence is the main cause of breast cancer-related deaths. Tumour cell proliferation and migration are crucial steps in the metastatic process. Several perioperative factors, including general anaesthesia and opioid analgesia, adversely affect immune function, potentially increasing metastatic recurrence. Regional anaesthesia-analgesia has been consistently shown to attenuate the stress response to surgery, and also reduce opioid and general anaesthesia requirements, thereby attenuating this perioperative immunosuppression. We investigated the effect of serum from breast cancer surgery patients who received different anaesthetic techniques on breast cancer cell function in vitro. Patients were randomized to receive propofol/paravertebral anaesthesia-analgesia (propofol/paravertebral, n=11) or sevoflurane general anaesthesia with opioid analgesia (sevoflurane/opioid, n=11). The ER-negative MDA-MB-231 cell line was treated with patient serum from both groups. The effects on proliferation and migration were measured. Treatment groups were well balanced for age, weight, surgical procedure, and cancer pathology. Pain scores were lower at 1 and 2 h in the propofol/paravertebral analgesia group. Compared with preoperative values, proliferation of MDA-MB-231 cells treated with postoperative patient serum at 10% concentration from the propofol/paravertebral group was significantly reduced compared with the sevoflurane/opioid group (-24% vs 73%, P=0.01). There was no significant change in MDA-MB-231 cell migration after treatment with patient serum between the two groups. Serum from patients receiving propofol/paravertebral anaesthesia for breast cancer surgery inhibited proliferation, but not migration, of ER-MDA-MB-231 cells in vitro, to a greater extent than that from patients receiving sevoflurane/opioid anaesthesia-analgesia. This implies that anaesthetic technique alters the serum molecular milieu in ways that may affect breast cancer cell function, possibly by altering anaesthetic and opioid drug administration and resultant pain scores.