On your surgery day

Nutrition

The American Society of Anesthesiologists no longer recommends long fasts before surgery.

Research shows benefits from drinking a clear, carbohydrate-rich beverage 2 to 3 hours before surgery instead of a long fast.1Tebala GD, Gordon-Dixon A, Imtiaz M, Shrestha A, Toeima M. Enhanced recovery after rectal surgery: what we have learned so far. Mini-invasive Surgery. 2018;2:32.

Pain control during surgery

The type of anesthesia and pain control you use can affect many outcomes:

  • Your experience of pain 
  • Your risk for infection 
  • Your appetite 
  • Your ability to urinate or have a bowel movement 
  • Your risk of cancer recurrence (limited data)

Every person is different, and your pain control needs to be tailored to your situation and needs. We strongly encourage you to explore all pain-management options with your surgeon and anesthesiologist. Then make choices that fit your situation and goals.

Pain is one of the main contributors to the stress response during surgery—especially major surgery. The experience of pain can promote the release of stress hormones. A longer stress response after surgery is linked to worse outcomes, such as stress-related insulin resistance, greater risk of functional decline after surgery, and impaired organ function.5Tebala GV, Gordon-Dixon A, Imtiaz M, Shrestha A, Toeima M. Enhanced recovery after rectal surgery: what we have learned so far. Mini-invasive Surgery. 2018;2:32; Minnella EM, Carli F. Prehabilitation and functional recovery for colorectal cancer patients. European Journal of Surgical Oncology. 2018;44(7):919-926. 

But on the other side of this equation, some types of anesthetic drugs and delivery methods are linked to higher risk of recurrence.6Biki B, Mascha E et al. Anesthetic technique for radical prostatectomy surgery affects cancer recurrence: a retrospective analysis. Anesthesiology. 2008 Aug;109(2):180-7; Brand JM, Kirchner H, Poppe C, Schmucker P. The effects of general anesthesia on human peripheral immune cell distribution and cytokine production. Clinical Immunology and Immunopathology. 1997 May;83(2):190-4. A balance between pain control benefits and risks is the goal. We encourage controlling pain with the safest and most effective methods available in each situation.

Medications to manage pain 

Examples of pain-control options during surgery, sometime started before surgery:

  • Continuous surgical wound infiltration with local anesthetics: local anesthetic medication is pumped into the surgical site
  • Multimodal pain management protocol: an approach using non-opioid analgesic techniques is an integral component of enhanced recovery after surgery protocols described on Preparing for surgery ›
  • Local nerve blocks, a direct injection in a nerve or space around a nerve to block pain:
    • Transversus abdominis plane block (TAP): a nerve injection designed to anesthetize the nerves in your abdominal wall. This can be helpful if you are going to have an incision on your abdomen. 
    • Quadratus lumborum block (QLB): a variant of the transversus abdominis plane block (TAP) (above) to anesthetize the posterior (back) abdominal wall
    • Neuraxial anesthesia: an anesthetic is injected near the spinal cord
  • Ketorolac: a nonsteroidal anti-inflammatory drug (NSAID) that is given intravenously 
  • Oral medications: opioids, NSAIDs such as Motrin, acetaminophen (Tylenol), and other medications; be sure to ask your team about the purpose of any medication you are given and its side effects.

Pain control: connection to survival and reducing cancer proliferation or recurrence

Anesthesia

Insufficient and conflicting evidencepreclinical evidence only OR clinical studies with such poor or unclear methodology that no conclusion can be drawn OR conflicting findings across clinical studies with no preponderance of evidence in one direction; conflicting evidence occurs when studies find conflicting effects (positive effect vs no effect or negative effect) with the same treatment and the same general study population (same cancer type, for example) (this is the CancerChoices definition; other researchers and studies may define this differently) of any effect on recurrence or survival after surgery among people, mostly with cancer, treated with regional anesthesia (epidural, paravertebral blocks, neuraxial anesthesia) compared to general anesthesia

Preliminary (conflicting) evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) of better survival with either total intravenous anesthesia (TIVA) or regional anesthesia compared to volatile anesthetics

Prescription drugs

Better survival among people with breast cancer, kidney cancer, or lung cancer treated with ketorolac around the time of surgery (preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently))

Keep reading about integrative approaches to surgery

Authors

Laura Pole, RN, MSN, OCNS

Senior Clinical Consultant
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Laura Pole is senior clinical consultant for CancerChoices. Laura is an oncology clinical nurse specialist who has been providing integrative oncology clinical care, navigation, consultation, and education services for over 40 years. She is the co-creator and co-coordinator of the Integrative Oncology Navigation Training at Smith Center for Healing and the Arts in Washington, DC. Laura also manages the “Media Watch Cancer News That You Can Use” listserv for Smith Center/Commonweal. In her role as a palliative care educator and consultant, Laura has served as statewide Respecting Choices Faculty for the Virginia POST (Physician Orders for Scope of Treatment) Collaborative as well as provided statewide professional education on palliative and end-of-life care for the Virginia Association for Hospices and Palliative Care.

For CancerChoices, Laura curates content and research, networks with clinical and organizational partners, brings awareness and education of integrative oncology at professional and patient conferences and programs, and translates research into information relevant to the patient experience as well as clinical practice.

Laura sees her work with CancerChoices as a perfect alignment of all her passions, knowledge and skills in integrative oncology care. She is honored to serve you.

Laura Pole, RN, MSN, OCNS Senior Clinical Consultant

Nancy Hepp, MS

Lead Researcher and Program Manager
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Ms. Hepp is a researcher and communicator who has been writing and editing educational content on varied health topics for more than 20 years. She serves as lead researcher, program manager, and writer for CancerChoices. Her graduate work in research and cognitive psychology, her master’s degree in instructional design, and her certificate in web design have all guided her in writing and presenting information for a wide variety of audiences and uses. Nancy’s service as faculty development coordinator in the Department of Family Medicine at Wright State University also provided experience in medical research, plus insights into medical education and medical care from the professional’s perspective.

Nancy Hepp, MS Lead Researcher and Program Manager

Reviewer

Whitney You, MD, MPH

Research Consultant
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Dr. You is a physician specializing in maternal-fetal medicine (MFM) with a specific interest in cancer in the context of pregnancy. She completed a postdoctoral fellowship in health services research with a focus in health literacy and received a Master of Public Health.

Whitney You, MD, MPH Research Consultant

Last update: June 20, 2022

CancerChoices provides information about integrativein cancer care, a patient-centered approach combining the best of conventional care, self care and evidence-informed complementary care in an integrated plan cancer care. We review complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocial therapy, and acupuncture therapies and self-care lifestyle actions and behaviors that may impact cancer outcomes; examples include eating health-promoting foods, limiting alcohol, increasing physical activity, and managing stress practices to help patients and professionals explore and integrate the best combination of conventionalthe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy and complementary therapies and practices for each person.

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