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MINERVA ANESTESIOLOGICA

A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care


Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2017 May 12

DOI: 10.23736/S0375-9393.17.11881-X

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Scalp block for glioblastoma surgery is associated with lower inflammatory scores and improved survival

Lan ZHENG 1, Katherine B. HAGAN 2, John VILLARREAL 2, Visesh KEERTY 2, Jasper CHEN 3, Juan P. CATA 2, 4

1 Department of Cancer Biology, The University of Texas, Md Anderson Cancer Center, Houston, TX, USA; 2 Department of Anesthesiology and Perioperative Medicine, The University of Texas, Md Anderson Cancer Center, Houston, TX, USA; 3 University of Texas, Mc Govern Medical School, Housto, TX, USA; 4 Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA


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BACKGROUND: Regional anesthesia has anti-inflammatory effects. Recent studies suggest that regional anesthesia might improve the survival of patients with cancer. We hypothesized that the use of a scalp block (SB) during craniotomy for glioblastoma (GB) decreases the postoperative systemic and local inflammatory response and extend their survival.
METHODS: This retrospective study included 119 patients with GB who underwent tumor resection. We divided patients into 2 groups based on the use of SB during surgery. Preoperative and postoperative neutrophil-to-lymphocyte (NLR) ratio and platelet-to-lymphocyte (PLR) ratios were calculated as well as the percentage change in postoperative T2/FLAIR (FLuid-Attenuated Inversion Recovery) volume. Both markers of the inflammatory response were compared between patients with and without an SB. Progression-free survival (PFS) was also compared in both groups of patients. Univariate and multivariate analysis were used to test the association between SB and patients’ survival.
RESULTS: On day 3 after surgery, patients who had an SB showed statistically significant lower NLRs and PLRs than those without an SB. There was also a significant larger reduction in postoperative T2/FLAIR signal in patients with SB than in those without SB. The median PFS (progression-free survival) was longer in patients with SB (16.7 months) than those without an SB (6.5 months, p < 0.001). The multivariate analysis indicated that the use of SB was an independent factor for longer PFS (hazard ratio: 0.31 95% confidence interval:0.07 - 0.21, p < 0.001).
CONCLUSIONS: This retrospective study supports the hypothesis that in patients with GB undergoing craniotomy, the use of SB is associated with lower levels of systemic and local inflammation, and longer survival.


KEY WORDS: Glioblastoma – Scalp - Anesthesia, Local – Craniotomy – Inflammation – Recurrence

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jcata@mdanderson.org