Effect of multimodal analgesia with paravertebral blocks on biochemical recurrence in men undergoing open radical prostatectomy

• Published in: Urologic oncology Vol. 36; no. 8; pp. 364.e9 - 364.e14
• Main Authors: Macleod, Liam C., Turner, Robert M., Lopa, Samia, Hugar, Lee A., Davies, Benjamin J., Ben-David, Bruce, Chelly, Jacques E., Jacobs, Bruce L., Nelson, Joel B.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2018
• Subjects: Anesthesia; Biochemical recurrence; Cancer surgery; Open prostatectomy; Prostate cancer; Regional analgesia; Anesthesia; Open prostatectomy; Regional analgesia; Biochemical recurrence; Prostate cancer; Cancer surgery
• ISSN: 1078-1439; 1873-2496
• DOI: 10.1016/j.urolonc.2018.05.016

Recent studies suggest that anesthetic technique during radical prostatectomy for prostate cancer may affect recurrence or progression. This association has previously been investigated in series that employ epidural analgesia. The objective of this study is to determine the association between the use of a multimodal analgesic approach incorporating paravertebral blocks and risk of biochemical recurrence following open radical prostatectomy. Using a prospective database of 3,029 men undergoing open radical prostatectomy by a single surgeon, we identified 2,909 men who received no neoadjuvant androgen deprivation and had at least 1 year of follow up. We retrospectively compared patients who received general analgesia with opioid analgesia (1999–2003, n = 662) to those who received general analgesia with multimodal analgesia incorporating paravertebral blocks (2003–2014, n = 2,247). The primary outcome was time to biochemical recurrence. Biochemical recurrence-free interval was assessed using the Kaplan-Meier technique and compared using a multivariate Cox-proportional hazards regression model. In total, 395 patients (14%) experienced biochemical recurrence following radical prostatectomy, including 265 (12%) who received multimodal analgesia and 130 (20%) who did not (adjusted P = 0.27). After adjusting for age, race, body mass index, preoperative prostate specific antigen, grade, stage, perineural invasion, margin status, percent of tumor in the gland, and diameter of the dominant nodule, there was no difference in recurrence-free interval between groups (HR = 0.92, 95% CI: 0.73–1.17). Use of a multimodal analgesic approach incorporating paravertebral blocks is not associated with a reduced risk of biochemical recurrence following radical prostatectomy. •There is controversy regarding possible anticancer effects of regional analgesia.•2,909 men having radical prostatectomy were analyzed.•Biochemical recurrence and survival were compared based on analgesia modality.•We found no significant benefit to regional analgesia on adjusted analysis.•Regional analgesia is beneficial for pain but not prostate cancer control.