• Andres Missair, Juan Pablo Cata, Gina Votta-Velis, Mark Johnson, Alain Borgeat, Mohammed Tiouririne, Vijay Gottumukkala, Donal Buggy, Ricardo Vallejo, Esther Benedetti de Marrero, Dan Sessler, Marc A Huntoon, Andres Jose De J Department of Anesthesiology, General University Hospital, Valencia, Spain., and Casasola Oscar De Leon OL Department of Anesthesiology, University of Buffalo / Roswell Park Cancer Institute, Buffalo, New York, USA..
• Department of Anesthesiology, Veterans Affairs Hospital, Miami, Florida, USA andres.missair@va.gov.
• Reg Anesth Pain Med. 2019 Jan 1; 44 (1): 13-28.

AbstractCancer causes considerable suffering and 80% of advanced cancer patients experience moderate to severe pain. Surgical tumor excision remains a cornerstone of primary cancer treatment, but is also recognized as one of the greatest risk factors for metastatic spread. The perioperative period, characterized by the surgical stress response, pharmacologic-induced angiogenesis, and immunomodulation results in a physiologic environment that supports tumor spread and distant reimplantation.In the perioperative period, anesthesiologists may have a brief and uniquewindow of opportunity to modulate the unwanted consequences of the stressresponse on the immune system and minimize residual disease. This reviewdiscusses the current research on analgesic therapies and their impact ondisease progression, followed by an evidence-based evaluation of perioperativepain interventions and medications.© American Society of Regional Anesthesia & Pain Medicine 2019. No commercial re-use. See rights and permissions. Published by BMJ.

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