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Li R, Xiao C, Liu H, Huang Y, Dilger JP, Lin J. Effects of local anesthetics on breast cancer cell viability and migration. BMC Cancer 2018; 18:666. [PMID: 29914426 PMCID: PMC6006780 DOI: 10.1186/s12885-018-4576-2] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 06/05/2018] [Indexed: 11/25/2022] Open
Abstract
Background Breast cancer accounts for nearly a quarter of all cancers in women worldwide, and more than 90% of women diagnosed with breast cancer undergo mastectomy or breast-conserving surgery. Retrospective clinical studies have suggested that use of regional anesthesia leads to improved patient outcomes. Laboratory studies have reported that breast cancer cells are inhibited by some local anesthetics at millimolar concentration. Here, we present a comprehensive analysis of the effects of six common local anesthetics on two human breast cancer cell lines. We used concentrations ranging from those corresponding to plasma levels during regional block by local anesthetic (plasma concentration) to those corresponding to direct infiltration of local anesthetic. Methods Human breast cancer cell lines, MDA-MB-231 and MCF7, were incubated with each of six local anesthetics (lidocaine, mepivacaine, ropivacaine, bupivacaine, levobupivacaine, and chloroprocaine) (10 μM ~ 10 mM) for 6 to 72 h. Assays for cell viability, cytotoxicity, migration, and cell cycle were performed. Results High concentrations (> 1 mM) of local anesthetics applied to either MDA-MB-231 or MCF7 cells for 48 h significantly inhibited cell viability and induced cytotoxicity. At plasma concentrations (~ 10 μM) for 72 h, none of the local anesthetics affected cell viability or migration in either cell line. However, at 10 × plasma concentrations, 72-h exposure to bupivacaine, levobupivacaine or chloroprocaine inhibited the viability of MDA-MB-231 cells by > 40% (p < 0.001). Levobupivacaine also inhibited the viability of MCF7 cells by 50% (p < 0.001). None of the local anesthetics affected the viability of a non-cancerous breast cell line, MCF10A. MDA-MB-231 cell migration was inhibited by 10 × plasma concentrations of levobupivacaine, ropivacaine or chloroprocaine and MCF7 cell migration was inhibited by mepivacaine and levobupivacaine (p < 0.05). Cell cycle analysis showed that the local anesthetics arrest MDA-MB-231 cells in the S phase at both 1 × and 10 × plasma concentrations. Conclusions Local anesthetics at high concentrations significantly inhibited breast cancer cell survival. At 10 × plasma concentrations, the effect of local anesthetics on cancer cell viability and migration depended on the exposure time, specific local anesthetic, specific measurement endpoint and specific cell line.
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Affiliation(s)
- Ru Li
- Department of Anesthesiology, Stony Brook University, Stony Brook, NY, USA
| | - Chunyun Xiao
- Department of Anesthesiology, Stony Brook University, Stony Brook, NY, USA
| | - Hengrui Liu
- Department of Anesthesiology, Stony Brook University, Stony Brook, NY, USA
| | - Yujie Huang
- Department of Anesthesiology, Stony Brook University, Stony Brook, NY, USA.,School of Dental Medicine, Stony Brook University, Stony Brook, NY, USA
| | - James P Dilger
- Department of Anesthesiology, Stony Brook University, Stony Brook, NY, USA.,Department of Physiology and Biophysics, Stony Brook University, Stony, Brook, NY, USA
| | - Jun Lin
- Department of Anesthesiology, Stony Brook University, Stony Brook, NY, USA. .,HSC L4-060, Stony Brook University Health Science Center, Stony Brook, NY, 11794-8480, USA.
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Should thoracic paravertebral blocks be used to prevent chronic postsurgical pain after breast cancer surgery? A systematic analysis of evidence in light of IMMPACT recommendations. Pain 2018; 159:1955-1971. [DOI: 10.1097/j.pain.0000000000001292] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Župčić M, Graf Župčić S, Duzel V, Šimurina T, Šakić L, Fudurić J, Peršec J, Milošević M, Stanec Z, Korušić A, Barišin S. A combination of levobupivacaine and lidocaine for paravertebral block in breast cancer patients undergoing quadrantectomy causes greater hemodynamic oscillations than levobupivacaine alone. Croat Med J 2017; 58:270-280. [PMID: 28857520 PMCID: PMC5577647 DOI: 10.3325/cmj.2017.58.270] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
AIM To test for differences in hemodynamic and analgesic properties in patients with breast cancer undergoing quadrantectomy with paravertebral block (PVB) induced with a solution of either one or two local anesthetics. METHOD A prospective, single-center, randomized, double-blinded, controlled trial was conducted from June 2014 until September 2015. A total of 85 women with breast cancer were assigned to receive PVB with either 0.5% levobupivacaine (n=42) or 0.5% levobupivacaine with 2% lidocaine (n=43). Hemodynamic variables of interest included intraoperative stroke volume variation (SVV), mean arterial pressure, heart rate, cardiac output, episodes of hypotension, use of crystalloids, and use of inotropes. Analgesic variables of interest were time to block onset, duration of analgesia, and postoperative serial pain assessment using a visual analogue scale. RESULTS Although the use of 0.5% levobupivacaine with 2% lidocaine solution for PVB decreased the mean time-to-block onset (14 minutes; P<0.001), it also caused significantly higher SVV values over the 60 minutes of monitoring (mean difference: 4.33; P<0.001). Furthermore, the patients who received 0.5% levobupivacaine with 2% lidocaine experienced shorter mean duration of analgesia (105 minutes; P=0.006) and more episodes of hypotension (17.5%; P=0.048) and received more intraoperative crystalloids (mean volume: 550 mL; P<0.001). CONCLUSION The use of 0.5% levobupivacaine in comparison with 0.5% levobupivacaine with 2% lidocaine solution for PVB had a longer time-to-block onset, but it also reduced hemodynamic disturbances and prolonged the analgesic effect.
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Affiliation(s)
- Miroslav Župčić
- Miroslav Župčić, Anesthesiology, Reanimatology and Intensive Care Medicine, Clinical Hospital Dubrava, Av. G. Šuška 6, 10000 Zagreb, Croatia,
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Choquette A, Troncy E, Guillot M, Varin F, del Castillo JRE. Pharmacokinetics of Lidocaine Hydrochloride Administered with or without Adrenaline for the Paravertebral Brachial Plexus Block in Dogs. PLoS One 2017; 12:e0169745. [PMID: 28068408 PMCID: PMC5221883 DOI: 10.1371/journal.pone.0169745] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 12/21/2016] [Indexed: 11/18/2022] Open
Abstract
Adrenaline is known to prolong the duration of local anesthesia but its effects on the pharmacokinetic processes of local anesthetic drugs are not fully understood. Our objective was to develop a compartmental model for quantification of adrenaline’s impact on the pharmacokinetics of perineurally-injected lidocaine in the dog. Dogs were subjected to paravertebral brachial plexus block using lidocaine alone or adrenalinated lidocaine. Data was collected through a prospective, randomised, blinded crossover protocol performed over three periods. Blood samples were collected during 180 minutes following block execution. Compartmental pharmacokinetic models were developed and their goodness-of-fit were compared. The lowering effects of adrenaline on the absorption of lidocaine were statistically determined with one-sided tests. A one-compartment disposition model with two successive zero-order absorption processes best fitted our experimental data. Adrenaline decreased the peak plasma lidocaine concentration by approximately 60% (P < 0.001), decreased this local anesthetic’s fast and slow zero-order absorption rates respectively by 50% and 90% (P = 0.046, and P < 0.001), which respective durations were prolonged by 90% and 1300% (P < 0.020 and P < 0.001). Lidocaine demonstrated a previously unreported atypical absorption profile following its paravertebral injection in dogs. Adrenaline decreased the absorption rate of lidocaine and prolonged the duration of its absorption.
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Affiliation(s)
- Amélie Choquette
- Québec’s Animal Pharmacology Research Group (GREPAQ), Department of Veterinary Biomedical Sciences, Université de Montréal, Saint-Hyacinthe, Québec, Canada
| | - Eric Troncy
- Québec’s Animal Pharmacology Research Group (GREPAQ), Department of Veterinary Biomedical Sciences, Université de Montréal, Saint-Hyacinthe, Québec, Canada
| | - Martin Guillot
- Québec’s Animal Pharmacology Research Group (GREPAQ), Department of Veterinary Biomedical Sciences, Université de Montréal, Saint-Hyacinthe, Québec, Canada
| | - France Varin
- Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada
| | - Jérôme R. E. del Castillo
- Québec’s Animal Pharmacology Research Group (GREPAQ), Department of Veterinary Biomedical Sciences, Université de Montréal, Saint-Hyacinthe, Québec, Canada
- * E-mail:
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Ultrasound-guided Multilevel Paravertebral Blocks and Total Intravenous Anesthesia Improve the Quality of Recovery after Ambulatory Breast Tumor Resection. Anesthesiology 2014; 120:703-13. [DOI: 10.1097/aln.0000436117.52143.bc] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Abstract
Background:
Regional anesthesia improves postoperative analgesia and enhances quality of recovery (QoR) after ambulatory surgery. This randomized, double-blinded, parallel-group, placebo-controlled trial examines the effects of multilevel ultrasound-guided paravertebral blocks (PVBs) and total intravenous anesthesia on QoR after ambulatory breast tumor resection.
Methods:
Sixty-six women were randomized to standardized general anesthesia (control group) or PVBs and propofol-based total intravenous anesthesia (PVB group). The PVB group received T1–T5 PVBs with 5 ml of 0.5% ropivacaine per level, whereas the control group received sham subcutaneous injections. Postoperative QoR was designated as the primary outcome. The 29-item ambulatory QoR tool was administered in the preadmission clinic, before discharge, and on postoperative days 2, 4, and 7. Secondary outcomes included block success, pain scores, intra- and postoperative morphine consumption, time to rescue analgesia, incidence of nausea and vomiting, and hospital discharge time.
Results:
Data from sixty-four patients were analyzed. The PVB group had higher QoR scores than control group upon discharge (146 vs. 131; P < 0.0001) and on postoperative day 2 (145 vs. 135; P = 0.013); improvements beyond postoperative day 2 lacked statistical significance. None of the PVB group patients required conversion to inhalation gas–based general anesthesia or experienced block-related complications. PVB group patients had improved pain scores on postanesthesia care unit admission and discharge, hospital discharge, and postoperative day 2; their intraoperative morphine consumption, incidence of nausea and vomiting, and discharge time were also reduced.
Conclusion:
Combining multilevel PVBs with total intravenous anesthesia provides reliable anesthesia, improves postoperative analgesia, enhances QoR, and expedites discharge compared with inhalational gas- and opioid-based general anesthesia for ambulatory breast tumor resection.
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Guay J, Grabs D. A cadaver study to determine the minimum volume of methylene blue or black naphthol required to completely color the nerves relevant for anesthesia during breast surgery. Clin Anat 2010; 24:202-8. [DOI: 10.1002/ca.21085] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2010] [Revised: 09/17/2010] [Accepted: 09/24/2010] [Indexed: 11/11/2022]
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Sopena-Zubiria LA, Fernández-Meré LA, Muñoz González F, Valdés Arias C. [Multiple-injection thoracic paravertebral block for reconstructive breast surgery]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2010; 57:357-363. [PMID: 20645487 DOI: 10.1016/s0034-9356(10)70248-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To describe the use of multiple-injection thoracic paravertebral blockade, with intravenous sedation, for anesthesia during reconstructive breast surgery. MATERIAL AND METHODS Descriptive, prospective study in 100 scheduled operations for major reconstructive breast surgery. The paravertebral block was performed by means of 3 injections at the lower edges of the vertebral apophyses at T3-5. We recorded time performing the procedure, latency (time until block onset), dermatomes blocked, degree of effectiveness, conversion to general anesthesia, postoperative complications and pain, and patient satisfaction. RESULTS Dermatomes T3, T4, and T5 were blocked in 99% of the patients. The block took 7.39 minutes to perform and latency was 7.37 minutes. Postoperative analgesia with anti-inflammatory drugs was adequate for most patients. There were 3 cases of epidural diffusion, 10 patients with hypotension, 12 with postoperative nausea or vomiting, and 3 with symptoms of epidural blockade. Intravascular puncture occurred, without complications, in 3 cases. There were no cases of pneumothorax or intrathecal injection. Ninety-one percent of the patients declared they were satisfied or very satisfied with the technique. CONCLUSIONS Triple-injection paravertebral blocks, in which 3 fractions of the total anesthetic dose are delivered to block dermatomes T3-5 is an effective technique that is easy to perform and leads to few complications. Most patients express a high degree of satisfaction with this anesthetic technique.
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Affiliation(s)
- L A Sopena-Zubiria
- Hospital Universitario Central de Asturias (HUCA), Centro Residencia Covadonga, Oviedo.
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Re: Thoracic Paravertebral Block for Percutaneous Transhepatic Biliary Drainage—Reply. J Vasc Interv Radiol 2006. [DOI: 10.1097/01.rvi.0000242211.76863.c0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Navlet MG, Garutti I, Olmedilla L, Pérez-Peña JM, San Joaquin MT, Martinez-Ragues G, Gomez-Caro L. Paravertebral Ropivacaine, 0.3%, and Bupivacaine, 0.25%, Provide Similar Pain Relief After Thoracotomy. J Cardiothorac Vasc Anesth 2006; 20:644-7. [DOI: 10.1053/j.jvca.2006.02.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2005] [Indexed: 11/11/2022]
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Garutti I, Olmedilla L, Pérez-Peña JM, Arnal D, Piñeiro P, Barrigon S, Navia J. Hemodynamic Effects of Lidocaine in the Thoracic Paravertebral Space During One-Lung Ventilation for Thoracic Surgery. J Cardiothorac Vasc Anesth 2006; 20:648-51. [DOI: 10.1053/j.jvca.2006.02.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2005] [Indexed: 11/11/2022]
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Gratz I, Deal E, Larijani GE, Domsky R, Goldberg ME. The number of injections does not influence absorption of bupivacaine after cervical plexus block for carotid endarterectomy. J Clin Anesth 2005; 17:263-6. [PMID: 15950849 DOI: 10.1016/j.jclinane.2004.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2004] [Accepted: 07/16/2004] [Indexed: 10/25/2022]
Abstract
STUDY OBJECTIVE To investigate the efficacy and kinetics of bupivacaine when used for deep cervical plexus block (CPB), using either a single-injection or multiple-injections technique. DESIGN Prospective, randomized, double-blind study. SETTING Operating room of a university hospital. PATIENTS Twenty-four adult patients (16 men, 8 women) scheduled for carotid endarterectomy. INTERVENTIONS Patients were randomly assigned to receive CPB either by a single injection or after 3 injections. Patients in the multiple-injections group received a total dose of 15 mL of 0.5% bupivacaine (5 mL each deposited at C2, C3, and C4 over 2 minutes). Patients in the single-injection group received a single 15-mL injection of 0.5% bupivacaine. After the deep CPB, a superficial CPB was performed with 20 mL of 0.5% bupivacaine in all patients. MEASUREMENTS An anesthesiologist and a surgeon graded the success of the block. Arterial plasma concentrations of bupivacaine were measured using liquid chromatography-mass spectroscopy. MAIN RESULTS No significant differences were seen between the 2 groups with respect to the mean peak concentration of bupivacaine (single injection 2314 +/- 1385 ng/mL vs multiple injections 2255 +/- 1105 ng/mL) or time to reach the maximal concentration (time to maximum concentration [single injection 12.1 +/- 7.2 minutes vs multiple injections 12.5 +/- 3.9 minutes]). Furthermore, there were no significant differences in mean block scores between the single-injection and the multiple-injections groups, evaluated either by the anesthesiologists or the surgeon. CONCLUSIONS The results of this study showed that the absorption of bupivacaine is independent of the number of injections after CPB, and that anesthesia for carotid endarterectomy may be accomplished successfully using either technique.
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Affiliation(s)
- Irwin Gratz
- Department of Anesthesiology, Cooper Hospital, Camden, NJ 08103, USA
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Lemay E, Guay J, Côté C, Leclerc YE. Le bloc paravertébral n’est pas une technique anesthésique de choix pour la chirurgie mammaire mineure en court séjour. Can J Anaesth 2004; 51:852-3. [PMID: 15470182 DOI: 10.1007/bf03018468] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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