[Perioperative analgesia in urology and potential influence of anesthesia on oncologic outcomes of surgery].
BACKGROUND
The objective of the current article was to present a review concerning current concepts of perioperative analgesia in urology and to assess the potential influence of anesthesia on oncologic outcomes after surgery.


METHODS
Data on general anesthesia and perioperative analgesia were explored on Medline using the following MeSH terms: anesthesia; analgesia; pain urology; cancer; morphine; nefopam; tramadol; ketamine; local anesthetics; non-steroid anti-inflammatory treatments; surgery; cancer. Publications were considered on the following criteria: methodology, relevance and date of publication.


RESULTS
The concepts of acute and chronic pain after surgery are discussed, as well as prevention and treatment. Types of available pharmacological substances are listed and the possible routes of administration for these products. The concept of multimodal analgesia and preemptive analgesia are exposed and their role for the prevention of perioperative pain. Recent studies suggest a relationship between the modes of anesthesia and analgesia in cancer surgery, and recurrence of the disease after surgery.


CONCLUSIONS
Current concepts of perioperative analgesia offer new perspectives to urologists in the management of pain. Current scientific literature advocates regional anesthesia, the fight against pain and stress, and decreased use of opioids. In addition, the use of a multimodal analgesia seems to be an option for an optimal oncologic management of urologic tumours.
Service d'anesthésie-réanimation, hôpital Pitié-Salpétrière, faculté de médecine Pierre-et-Marie-Curie, université Paris VI, AP-HP, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
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Corsia
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Chatti
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Coriat
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Chartier-Kastler
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Bitker
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Rouprêt
D000700:Analgesics / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000627:therapeutic use; D006801:Humans; D006930:Hyperalgesia / Q000517:prevention & control; D010149:Postoperative Pain / Q000517:prevention & control*; D019990:Perioperative Care; D013519:Urogenital Surgical Procedures
D000700:Analgesics; D000779:Anesthetics, Local