The Effect of Regional Anesthesia on Breast Cancer Recurrence Open Access
Martini, Reema (Spring 2025)
Abstract
Introduction:
Breast cancer is a significant cause of morbidity and mortality and is the second-leading cause of cancer related deaths among women in the United States. The mainstay for treatment is often surgery in the form of mastectomy or lumpectomy with or without lymph node dissection. Unfortunately, breast cancer recurrence despite curative-intent surgery remains a major issue. Regional anesthesia, which involves injecting local anesthetic to target specific nerves, may improve postoperative immunity and decrease the likelihood of cancer recurrence. We therefore investigated the impact of regional anesthesia (and other pre- and peri-operative factors such as opioid use) on breast cancer recurrence.
Furthermore, disparities in pain management and interventional pain techniques are well-documented. Given that regional anesthesia remains underutilized in breast surgeries despite known benefits of improved pain control and postoperative recovery, we investigated potential disparities in its administration and explored factors contributing to its variability in clinical practice.
Methods:
This is a retrospective data analysis of 1,762 Emory University patients who underwent primary breast cancer surgery at Emory hospitals from 2013-2024.
Results:
There is no association between regional anesthesia and breast cancer recurrence (adjusted hazards ratio [aHR]: 1.138; 95% confidence interval [CI]: 0.273 - 4.739; p: 0.8594). However, chronic opioid use after surgery was associated with an increased hazard of recurrence (aHR: 1.972; CI: 1.086 - 3.579; p: 0.0256). Furthermore, Black patients had a lower odds of receiving regional anesthesia compared to White patients (adjusted odds ratio [aOR]: 0.324; CI: 0.160 - 0.655; p: 0.0017).
Conclusion:
Regional anesthesia does not have a direct impact on breast cancer recurrence. However, chronic opioid use after surgery nearly doubled the hazard of recurrence, and this risk was most pronounced among patients who were opioid-naïve at the time of surgery and taking >90 morphine milligram equivalents daily. It is therefore vital to avoid opioids in this patient population.
In addition, racial disparities persist in regional anesthesia administration for breast cancer recurrence. These inequities are a result of systemic, provider, and patient-related factors, which must be addressed with standardized analgesic protocols to ensure equitable pain management.
Table of Contents
Narrative Review/Background 1
Methods 7
Results 9
Discussion 13
Conclusions 17
References 18
Figures 22
Tables 26
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