Comparison of the effect of erector spinae plane block for postoperative analgesia on neutrophil/lymphocyte ratio and platelet/lymphocyte ratio in patients operated for breast cancer

Abstract

Objectives: It was seen that recurrence and metastasis after breast cancer surgery are related to the immune response of the host. Anesthetic agents modulate the surgical stress response or directly impair the functions of immune system cells. In our study, we aimed to compare the effects of nonsteroidal anti-inflammatory drugs and erector spinae plane block, which are among the methods we use for postoperative analgesia, on the neutrophil/lymphocyte ratio and platelet/lymphocyte ratio in patients undergoing breast cancer surgery.

Methods: One hundred female patients aged 18-75 years, scheduled for unilateral breast cancer surgery, and who agreed to participate were included in our study. These cases were divided into two groups of the analgesia method: Those with erector spinae plane block (Group E) and those who were administered nonsteroidal anti-inflammatory drugs (Group N). According to the results, preoperative and postoperative neutrophil/lymphocyte ratio and platelet/lymphocyte ratio values were calculated and recorded.

Results: Neutrophil/lymphocyte ratio and platelet/lymphocyte ratio were statistically higher in both groups in the postoperative period. No statistically significant difference was found when the preoperative and postoperative measurement changes of the laboratory parameters between the groups were compared. Postoperative VAS scores were statistically significantly lower in Group E.

Conclusions: We concluded that when erector spinae plane block and nonsteroidal anti-inflammatory drug use were compared in managing postoperative analgesia in breast cancer surgery, their effects on the neutrophil/lymphocyte ratio and platelet/lymphocyte ratio were not superior to each other. However, the erector spinae plane block was superior for adequate pain control.

Keywords

• Breast cancer
• neutrophil/lymphocyte ratio (NLR)
• platelet/lymphocyte ratio (PLR)
• erector spinae plane block (ESPB)
• stress response

References

1. 1. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-249. doi: 10.3322/caac.21660.
2. 2. Kresovich JK, O'Brien KM, Xu Z, Weinberg CR, Sandler DP, Taylor JA. Prediagnostic Immune Cell Profiles and Breast Cancer. JAMA Netw Open. 2020;3(1):e1919536. doi: 10.1001/jamanetworkopen.2019.19536.
3. 3. Denkert C, Loibl S, Noske A, et al. Tumor-associated lymphocytes as an independent predictor of response to neoadjuvant chemotherapy in breast cancer. J Clin Oncol. 2010;28(1):105-113. doi: 10.1200/JCO.2009.23.7370.
4. 4. Nieswandt B, Hafner M, Echtenacher B, Männel DN. Lysis of tumor cells by natural killer cells in mice is impeded by platelets. Cancer Res. 1999;59(6):1295-300.
5. 5. Raigon Ponferrada A, Guerrero Orriach JL, Molina Ruiz JC, Romero Molina S, Gómez Luque A, Cruz Mañas J. Breast Cancer and Anaesthesia: Genetic Influence. Int J Mol Sci. 2021;22(14):7653. doi: 10.3390/ijms22147653.
6. 6. Dockrell L, Buggy DJ. The role of regional anaesthesia in the emerging subspecialty of onco-anaesthesia: a state-of-the-art review. Anaesthesia. 2021;76 Suppl 1:148-159. doi: 10.1111/anae.15243.
7. 7. Sethuraman RM. Regional anesthesia techniques for surgical anesthesia in breast cancer procedures. Can J Anaesth. 2022;69(11):1426-1427. doi: 10.1007/s12630-022-02313-1.
8. 8. Hu Y, Li M, Li J, Lyu Q, Jiang R, Du Y. Effects of ultrasound-guided erector spinae plane block on the immune function and postoperative recovery of patients undergoing radical mastectomy. Gland Surg. 2021;10(10):2901-2909. doi: 10.21037/gs-21-603.

9. 9. Gilmore N, Mohile S, Lei L, et al. The longitudinal relationship between immune cell profiles and frailty in patients with breast cancer receiving chemotherapy. Breast Cancer Res. 2021;23(1):19. doi: 10.1186/s13058-021-01388-w.
10. 10. Templeton AJ, Ace O, McNamara MG, et al. Prognostic role of platelet to lymphocyte ratio in solid tumors: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev. 2014;23(7):1204-1212. doi: 10.1158/1055-9965.EPI-14-0146.
11. 11. Greten FR, Grivennikov SI. Inflammation and Cancer: Triggers, Mechanisms, and Consequences. Immunity. 2019;51(1):27-41. doi: 10.1016/j.immuni.2019.06.025.
12. 12. Lombardi G, Berjano P, Cecchinato R, et al. Peri-Surgical Inflammatory Profile Associated with Mini-Invasive or Standard Open Lumbar Interbody Fusion Approaches. J Clin Med. 2021;10(14):3128. doi: 10.3390/jcm10143128.
13. 13. Karišik M, Gligorović Barhanović N, Vulović T, Simić D. Postoperative pain and stress response: does child's gender have an influence? Acta Clin Croat. 2019;58(2):274-280. doi: 10.20471/acc.2019.58.02.10.
14. 14. Smith L, Cata JP, Forget P. Immunological Insights into Opioid-Free Anaesthesia in Oncological Surgery: A Scoping Review. Curr Oncol Rep. 2022;24(10):1327-1336. doi: 10.1007/s11912-022-01300-5.
15. 15. Krenn-Pilko S, Langsenlehner U, Thurner EM, et al. The elevated preoperative platelet-to-lymphocyte ratio predicts poor prognosis in breast cancer patients. Br J Cancer. 2014;110(10):2524-2530. doi: 10.1038/bjc.2014.163.
16. 16. Gündüz S, Göksu SS, Arslan D, et al. Factors affecting disease-free survival in patients with human epidermal growth factor receptor 2-positive breast cancer who receive adjuvant trastuzumab. Mol Clin Oncol. 2015;3(5):1109-1112. doi: 10.3892/mco.2015.610.
17. 17. Abdella AMMR, Arida EEAEM, Megahed NA, El-Amrawy WZ, Mohamed WMA. Analgesia and spread of erector spinae plane block in breast cancer surgeries: a randomized controlled trial. BMC Anesthesiol. 2022;22(1):321. doi: 10.1186/s12871-022-01860-w.
18. 18. Altıparmak B, Korkmaz Toker M, Uysal Aİ, Turan M, Gümüş Demirbilek S. Comparison of the effects of modified pectoral nerve block and erector spinae plane block on postoperative opioid consumption and pain scores of patients after radical mastectomy surgery: A prospective, randomized, controlled trial. J Clin Anesth. 2019;54:61-65. doi: 10.1016/j.jclinane.2018.10.040.
19. 19. Li H, Zheng X. Response to the concerns about erector spinae plane block and anterior sympathetic chain spread. Reg Anesth Pain Med. 2020;45(12):1028. doi: 10.1136/rapm-2020-101458.
20. 20. Wigmore T, Farquhar-Smith P. Opioids and cancer: friend or foe? Curr Opin Support Palliat Care. 2016;10(2):109-118. doi: 10.1097/SPC.0000000000000208.
21. 21. Shavit Y, Ben-Eliyahu S, Zeidel A, Beilin B. Effects of fentanyl on natural killer cell activity and on resistance to tumor metastasis in rats. Dose and timing study. Neuroimmunomodulation. 2004;11(4):255-260. doi: 10.1159/000078444.
22. 22. Chen Q, Liang J, Liang L, Liao Z, Yang B, Qi J. Neutrophil-to-Lymphocyte Ratio as an Indicator of Opioid-Induced Immunosuppression After Thoracoscopic Surgery: A Randomized Controlled Trial. J Pain Res. 2022;15:1855-1862. doi: 10.2147/JPR.S371022.
23. 23. Cairat M, Al Rahmoun M, Gunter MJ, Severi G, Dossus L, Fournier A. Use of nonsteroidal anti-inflammatory drugs and breast cancer risk in a prospective cohort of postmenopausal women. Breast Cancer Res. 2020;22(1):118. doi: 10.1186/s13058-020-01343-1.
24. 24. Klifto KM, Elhelali A, Payne RM, Cooney CM, Manahan MA, Rosson GD. Perioperative systemic nonsteroidal anti-inflammatory drugs (NSAIDs) in women undergoing breast surgery. Cochrane Database Syst Rev. 2021;11(11):CD013290. doi: 10.1002/14651858.CD013290.pub2.
25. 25. Forget P, Bentin C, Machiels JP, Berliere M, Coulie PG, De Kock M. Intraoperative use of ketorolac or diclofenac is associated with improved disease-free survival and overall survival in conservative breast cancer surgery. Br J Anaesth. 2014;113 Suppl 1:i82-87. doi: 10.1093/bja/aet464.