Recent trends in anaesthesia and analgesia for breast cancer surgery

General, regional and local anaesthesia have all been employed for breast cancer surgery with good results. However, they differ in their side effect and complications profile. With the increase in the incidence and detection of breast cancer, evidence is accumulating towards the choice of anaesthetic technique affecting its recurrence and metastasis rate. This review aims to address the role of the anaesthesiologist in modern day breast cancer surgery, with focus on measures to reduce its recurrence and achieving peri-operative patient safety for primary, robotic and reconstructive breast cancer surgery. It also highlights the recent paradigm shift from general opioid-based anaesthesia to regional anaesthesia, based on prospective animal and retrospective human studies. The authors recommend the combination of total intravenous anaesthesia with propofol and regional anaesthesia (especially the newer PECS blocks) but not inhalation anaesthesia with morphine for the patients with breast cancer undergoing surgery. Medline, Embase, and Scopus databases were searched using keywords: breast cancer; recurrence; anaesthetic technique; paravertebral block; pectoralis blocks.