Örebro Studies in Medicine 237 I
ÖREBRO 2021 2021W
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wiebke falk, née Siekmann, was born in Bielefeld, Germany in 1978. She received her medical degree at the Charité Berlin in 2005. In 2006, she started her residency in Anaesthesiology and Intensive Care at Örebro University Hospital and became a specialist in 2011. She is currently working as a senior consultant at the Department of Anaesthesiology and Intensive care in Örebro. In 2014, she registered as a PhD student at Örebro University. This thesis was conducted under the supervision of Asso-ciate Professor Anil Gupta, Karolinska University Hospital and Karolinska Institutet, Stockholm (previously Associate Professor at Örebro University). Epidural analgesia has been used for pain relief during and after colorectal cancer (CRC) surgery. A possible beneficial effect of perioperative epidural analgesia on cancer recurrence and survival has been proposed from retro-spective studies, but remains unproven. This thesis presents four studies investigating in vitro effects of local anaesthetics on cell proliferation and different aspects of epidural analgesia in colorectal cancer surgery.
Study I showed that lidocaine and ropivacaine, two common local anaesthetics, do not reduce viability and proliferation of primary and me-tastatic colon cancer cell lines (SW480 and SW620 respectively) in vitro at concentrations normally achieved systemically in vivo. In study II, only minor and short-lasting effects of epidural analgesia on plasma cytokines (markers of inflammation) could be detected compared to intravenous analgesia with morphine. In a retrospective database study, we found that epidural analgesia did not reduce short- or long-term mortality, or postoperative complications after CRC surgery (study III). Finally, there was no significant difference in disease-free survival between patients randomised to epidural analgesia or patient-controlled intravenous analgesia with morphine after CRC surgery, although patients reported lower pain scores with epidural analgesia during the first postoperative day but not thereafter (study IV).
In conclusion, epidural analgesia offers better pain relief early after surgery for colorectal cancer. However, in this thesis, no other beneficial effects of epidural analgesia were seen in patients undergoing open or minimally invasive colorectal cancer surgery.
issn 1652-4063 isbn 978-91-7529-384-4
