Regional Anesthesia Superior to General Anesthesia in Melanoma Surgery

15 Nov

According to research presented at the American Society of Anesthesiologists (ASA) 2010 Annual Meeting recently held in San Diego, California, regional anesthesia gives melanoma patients their best chance for survival.

More specifically, when regional anesthesia is used during lymph node dissection, there is a better long-term prognosis than when using general anesthesia.

“We have good information from animal studies, and our understanding of the tumor [is telling us] that we should expect surgery [to be] risky for our patients,” Gerhard Brodner, MD, PhD, professor of anesthesiology at Fachklinik Hornheide in Muenster, Germany.

The researchers conducted a retrospective study using the medical records of 273 patients who underwent inguinal lymph node dissection after the diagnosis of primary malignant melanoma of the leg. The patients received either spinal or general anesthesia.

There were 52 patients who were given spinal anesthesia (bupivacaine 0.5%) and 221 patients who were given general anesthesia, which was either a balanced anesthesia with sevoflurane and sufentanil (n = 118) or as total intravenous anesthesia with propofol and remifentanil (n = 103). The analysis revealed that patients who received spinal anesthesia had a better survival rate over 10 years than those receiving general anesthesia.

The session’s moderator, Daniel Sessler, MD, professor of outcomes research at The Cleveland Clinic in Ohio, says that there have been a series of retrospective studies on the effects of regional and general anesthesia which have come up with mixed results in different tumors.

While Dr. Brodner says that anesthesiologists “should avoid everything that could harm the balance between the immune system and tumor cells,” Dr. Sessler says that “We really need to wait for prospective data. This is an intriguing theory, but it’s absolutely not a basis for altering practice. There’s good basic science, and strong animal data to support it. It’s the human data that we’re having problems with.”