Local anaesthetics and regional anaesthesia and outcome in cancer patients – What is the clinical evidence?

Cancer remains a large healthcare and socio-economic burden worldwide. New cancer cases are predicted to increase to over 35 million cases in 2050. Surgery remains the mainstay curative approach for solid tumour. Despite advancements in surgery and oncology diagnostics and therapeutics, cancer often recurs. Surgery and anaesthesia produce significant physiological changes that may dampen immune function, thus promoting cancer progression. The effects of regional anaesthesia and local anaesthetics have been explored to mitigate the risk of cancer recurrence. In this review, we summarise the current evidence of regional anaesthesia and local anaesthetics on cancer outcomes. Despite positivity in preclinical trials, prospective randomised trials have not produced convincing results. Other than the peritumoral local anaesthetic infiltration, studies have only suggested a neutral effect on long term outcome. Until new positive studies are available, regional anaesthesia and local anaesthetic use should be based on clinical grounds, not on potential oncological outcome benefit.