TORADOL (ketorolac) linked to Recurrence Prevention

Options
1…1516182021

Comments

  • darcy193
    darcy193 Member Posts: 2
    edited October 2015

    Thank you, Falleaves. Futher investigation uncovered the following, which was somewhat reassuring: http://www.ncbi.nlm.nih.gov/pubmed/26207518

    Nevertheless, if there are other pain-relieving options available to my aunt that might be safer, it is certainly worth looking into.

    There are just so many unknowns out there that I can't help but wonder what other factors come into play that could be increasing the chance of recurrence. It is frustrating and worrying but I think the best thing she (and I) can do is just keep on top of the latest findings making the most sensible decisions based upon what is known now, eat healty, exercise, and above all, live and enjoy life.

    · Share on FacebookShare on Twitter
  • 123JustMe
    123JustMe Member Posts: 385
    edited October 2015

    That's good news!  Thanks darcy!

    · Share on FacebookShare on Twitter
  • Fallleaves
    Fallleaves Member Posts: 806
    edited October 2015

    I agree, Darcy, that Danish study is reassuring. I don't know if you saw the thread I started for opioids and BC (I did include the Danish study, too), but here's the link in case you didn't see it: https://community.breastcancer.org/forum/73/topic/...

    I absolutely agree with your prescription for avoiding recurrence, especially enjoying life! You do the things you can, and then you let it go and focus on living. Sounds like your aunt is not a worrier, which is probably to her benefit. And she's got you looking out for her!

    · Share on FacebookShare on Twitter
  • sas-schatzi
    sas-schatzi Member Posts: 19,603
    edited November 2015

    Bump

    · Share on FacebookShare on Twitter
  • Stephmoen
    Stephmoen Member Posts: 563
    edited November 2015

    hello all hope everyone is doing well! I am having my implants and an oopherectomy nov 25 since I had a complete response to chemo and had issues last time with hematoma I'm not going to push for Torodal prior to surgery this go around hope I'm not making a mistake but I don't want any issues to delay healing

    · Share on FacebookShare on Twitter
  • Fallleaves
    Fallleaves Member Posts: 806
    edited November 2015

    Hi Stephmoen! So glad to see you here. Hope you've been doing great, and the healing has gone well. I think your decision about Toradol makes complete sense.

    Good luck with your surgeries on Nov. 25th (guess you won't be cooking on Thanksgiving!) Hope you have a much easier time with those surgeries. I'll be wishing you the very best. Please let us know how they go!

    By the way, the Mayo Clinic has developed an enhanced recovery after surgery pathway for breast reconstruction that you might want to take a look at, if you haven't seen it already.

    http://newsnetwork.mayoclinic.org/discussion/new-a...

    http://journals.lww.com/oncology-times/Fulltext/20...


    · Share on FacebookShare on Twitter
  • geewhiz
    geewhiz Member Posts: 1,439
    edited November 2015

    Hi ladies,


    I am headed for a recon pre-op tomorrow and want to have a stack of studies to show that I want keterolac. Did we have a list posted somewhere?

    Thanks!

    · Share on FacebookShare on Twitter
  • sas-schatzi
    sas-schatzi Member Posts: 19,603
    edited November 2015

    Geewhiz, Falls sent me a copy of a letter she wrote to her old doc. I asked that she revise it and post here. I would then erase the old doc letter from page 1 or pg 2. Time is short. Just in case Falls doesn't see your post, I'm reposting part of it. It's really well done :)

    Written by Falleaves November 2015

    Summarizing the papers I have read, inhaled anesthetics and opioids should be avoided because of their immunosuppressive effects. Opioids have also been implicated in increasing angiogenesis. Total intravenous anesthesia (TIVA) with propofol (which may reduce postoperative nausea) seems to suppress the inflammatory response to surgery. COX-2 inhibitors and NSAIDS, in particular preoperative ketorolac, could also reduce recurrence due to their anti-inflammatory properties, and their reduction of the need for opioids. Paravertebral nerve block (frequently with propofol) may be particularly valuable in reducing inflammatory cascades and preserving immune function, and reducing recurrence. It also provides better pain control than general anesthesia, reducing the need for opioids post surgery. Local anesthetics such as lidocaine and bupivicaine have been shown to cause apoptosis in breast cancer cells, and liposomal bupivacaine can provide good postsurgical analgesia and reduce the need for opioids. Preoperative gabapentin and pregabalin are effective in reducing postoperative pain and opioid use, and is preventive for chronic post surgical pain.

    Interestingly, many of the anesthetic choices that appear most likely to reduce recurrence, are also better for overall patient well-being. You may be familiar with enhanced recovery pathways. Johns Hopkins has developed an ERP for colorectal patients: "The goals of the perioperative anesthesiology pathway were achieving superior analgesia, minimizing postoperative nausea and vomiting, facilitating patient recovery, and preserving perioperative immune function...The perioperative anesthetic regimen was tailored to meet the goal of perioperative immune function (in an attempt to decrease surgical site infection and decrease cancer recurrence), in part by minimizing perioperative opioid use." http://www.ncbi.nlm.nih.gov/pubmed/26404073 The Mayo Clinic has created an ERP for breast reconstruction operations, as well. This includes preoperative analgesics and preventive nausea treatment, NSAIDS, liposomal bupivacaine, reduction in opioids post surgery, and resumption of eating and walking soon after surgery. http://newsnetwork.mayoclinic.org/discussion/new-approach-to-breast-reconstruction-surgery-reduces-opioid-painkiller-use-hospital-stays/

    It is my thought that if you are talking about a wide range of drugs and techniques that have ALL been tested, approved, and are in wide use, it is wise to favor those that do not promote the growth of cancer. Clearly anesthetics need to be tailored to each patient, but the impact on cancer recurrence should be a factor in the equation. It would be beneficial for breast cancer patients if an enhanced recovery pathway could be developed for them, with particular attention to use of drugs and techniques to reduce the chance of recurrence.

    You are a very busy person, and I realize anesthesia is not your area, but as the director of the Breast Center you are in a position to influence every aspect of care. I am linking some of the best studies I have found, and hope that you will share them with your anesthesiologists.

    Paravertebral block/Propofol

    "Can anesthestic technique for primary breast cancer surgery affect recurrence or metastasis?"

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1615712/

    "Efficacy and safety of paravertebral blocks in breast surgery: a meta-analysis of randomized controlled trials."
    http://www.ncbi.nlm.nih.gov/pubmed/20947592

    "Anesthesia technique may reduce breast cancer recurrence, death."
    http://www.sciencedaily.com/releases/2013/10/131015191057.htm

    "Thoracic paravertebral regional anesthesia improves analgesia after breast cancer surgery: a controlled randomized multicentre clinical trial"
    http://www.ncbi.nlm.nih.gov/pubmed/25480319

    Ketorolac

    "Intraoperative use of ketorolac or diclofenac is associated with improved disease-free survival and overall survival in conservative breast cancer surgery."
    http://www.ncbi.nlm.nih.gov/pubmed/24464611/

    "Reduction of Breast Cancer Relapse with Perioperative Non-Steroidal Anti-Inflammatory Drugs: New Findings and a Review"
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3831877/

    Local Anesthesia

    "Local anesthetics induce apoptosis in breast cancer cells"
    http://www.ncbi.nlm.nih.gov/pubmed/24247230

    "Evolving Role of Local Anesthestics in Managing Postsurgical Analgesia."
    http://www.ncbi.nlm.nih.gov/pubmed/25866297

    Gabapentin and Pregabalin
    "The Prevention of Chronic Postsurgical Pain Using Gabapentin and Pregabalin: A Combined Systemic Review and Meta-Analysis"
    http://www.ncbi.nlm.nih.gov/pubmed/22415535

    Review articles on Anesthesia and Cancer

    "The effects of anesthesia on tumor progression"
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3601457/#b58

    "Are we causing the recurrence-impact of perioperative period on long-term cancer prognosis: Review of currrent evidence and practice"
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4009631/


    · Share on FacebookShare on Twitter
  • sas-schatzi
    sas-schatzi Member Posts: 19,603
    edited November 2015

    Good luck Geewhiz. Keep us posted :

    · Share on FacebookShare on Twitter
  • geewhiz
    geewhiz Member Posts: 1,439
    edited November 2015

    Thank you so much!!! I really appreciate this!

    · Share on FacebookShare on Twitter
  • Loveroflife
    Loveroflife Member Posts: 5,563
    edited November 2015

    Once a nurse, always a nurse

    · Share on FacebookShare on Twitter
  • Fallleaves
    Fallleaves Member Posts: 806
    edited November 2015

    Oops, meant to post that! Thanks, Sassy!

    Geewhiz, hope the pre-op appt goes well. Also want to wish Stephmoen well with her day-before-Thanksgiving surgery!

    · Share on FacebookShare on Twitter
  • sas-schatzi
    sas-schatzi Member Posts: 19,603
    edited November 2015

    Falls, did I include the whole thing that needed to be included? Do you want to leave it the way it's posted? Usually I get OP permission before I repost something. I know you understand :)

    Stephy, good luck with surgery :)

    Loverly :)

    · Share on FacebookShare on Twitter
  • Fallleaves
    Fallleaves Member Posts: 806
    edited November 2015

    Sassy, looks fine to me. I appreciate your posting it (and you always have my permission, for anything!)

    · Share on FacebookShare on Twitter
  • Stephmoen
    Stephmoen Member Posts: 563
    edited November 2015

    thanks everyone looking forward with being done with the surgery part of my journey 😊 hope everyone is doing well!

    · Share on FacebookShare on Twitter
  • sas-schatzi
    sas-schatzi Member Posts: 19,603
    edited December 2015

    Hootie Hooo Geewhiz, How did you do with surgery?

    Hi, Rainyc, Stephie, Falls, 123, Solfeo, Peace and anyone else I forgot.

    · Share on FacebookShare on Twitter
  • peacestrength
    peacestrength Member Posts: 690
    edited December 2015

    Hi Sas.

    Anyone have recent experience with actually getting TIVA approved by yoursurgery team for reconstruction? My ps said it is "very expensive" and outside the comfort zone. I have yet to talk directly to the anesthesiologist.

    · Share on FacebookShare on Twitter
  • sas-schatzi
    sas-schatzi Member Posts: 19,603
    edited December 2015

    Peace, SpeiclaK is the most knowledgeable about TIVA.I think. I haven't studied it even though I worked within it i.e docs using it while I worked in the same OR. It was their thing. How the drugs worked in concept, It was their schitck. BUT and BUT Fallleaves has brought much to the discussion. The links to her threads are in the topic box.

    SpecialK, you have knowledge in this area. I remember the setup could run 4 drugs. Didn't care b/c I had no influence. Important now b/c it can influence outcome. ???

    · Share on FacebookShare on Twitter
  • sas-schatzi
    sas-schatzi Member Posts: 19,603
    edited December 2015

    I was going to delete my doc letter from some time ago and substitute the above post about Falleaves letter. I apparently revised my letter some time ago. Fuzzy memory, but seems to me I did it after rainnyc posted about revising it before her doc visit.

    The info in mine is different than the info in Falls. Opting to put the two together. Here's the link for anyone trying to find it.

    https://community.breastcancer.org/forum/73/topics/833612?page=7#post_4496841


    · Share on FacebookShare on Twitter
  • sas-schatzi
    sas-schatzi Member Posts: 19,603
    edited December 2015

    Peace, I went and started pulling info on TIVA. Total IV Anesthesia. As I stated in earlier posts. while not familiar with the TIVA term. It's just saying the all meds are delivered through a control device. TIVA while indicated that meds were all delivered by a device versus hand push, total iv use of drugs has been done back to the 1800's. My experience with it has been since the 70's.Think of the way it's used. TIVA---all drugs delivered by device versus tiva-- just means no gas was used. Think of it as Big T--little t.

    Basically, it's accomplishable and not sure why the doc would say it's expensive. The drugs used are common to the OR situation. Diprivan( propofol), and Sufentanil(stronger form of fentanyl). Diprivan(1980's) has to have a control device for delivery and always has. But that's been managed for decades. Sufentanil(1970's) has been used for decades as an IV push med, but can be delivered by a device.

    http://www.ebme.co.uk/articles/clinical-engineering/95-total-intravenous-anaesthesia-tiva

    Remifentanil a opiod as mentioned in the article, I have no familiarity with. But Falleaves may be able to jump in b/c of her extensive work in the opiod area.

    Since the focus of the research on opiods is that it may impact recurrence, then it would seem asking for this drug to be limited too makes sense. I'll use remifentanil as a keyword with BC and see what it pulls.

    · Share on FacebookShare on Twitter
  • TectonicShift
    TectonicShift Member Posts: 752
    edited July 2020

    .

    · Share on FacebookShare on Twitter
  • sas-schatzi
    sas-schatzi Member Posts: 19,603
    edited December 2015

    Tetonic Hi, met you on your thread. Falls did a thread two years ago now almost. I missed hers, but went looking for her when I started this thread. She and 123JustMe have become the trio.

    Need to shout out Geewhiz................HOOTIeHOOoooo

    · Share on FacebookShare on Twitter
  • TectonicShift
    TectonicShift Member Posts: 752
    edited July 2020

    .

    · Share on FacebookShare on Twitter
  • sas-schatzi
    sas-schatzi Member Posts: 19,603
    edited December 2015

    Techtonic, Now their both prophylactic. You have time to study and develop a plan.

    · Share on FacebookShare on Twitter
  • grandma3X
    grandma3X Member Posts: 759
    edited December 2015

    I'm new to this thread and scheduled for UMX with TEs on Jan. 13, so trying to get through all the posts here. I'm confused about some of the terminology - opioids is a general term but then specific drugs are often mentioned and I'm not sure which are opioids to be avoided and which ones are not. Could someone post a list of the drugs and how they are classified? And also what they are used for (postoperative pain, anesthetic used during surgery, etc. Thanks!

    · Share on FacebookShare on Twitter
  • Loveroflife
    Loveroflife Member Posts: 5,563
    edited December 2015

    image

    Sorry the table is not very clear. Brand names is in parenthesis.

    Morphine (Roxanol, MS Contin, Oramorph, Kadian)

    Fetanyl (Sublimaze, Duragesics)

    Hydromorphone (Dilaudid)

    Oxycodone (Roxicodone, Oxy IR, also found in Percocet, Percodan, Tylox)

    Meperidine (Demerol)

    Codeine (can be found in Tylenol #2, Tylenol #3, and Tylenol #4)

    Tramadol (Ultram)

    image

    · Share on FacebookShare on Twitter
  • Loveroflife
    Loveroflife Member Posts: 5,563
    edited December 2015

    List of NSAIDS (non-steroidal anti-inflammatory drugs)

    The one mentioned in the studies is ketorolac (Toradol)

    image

    · Share on FacebookShare on Twitter
  • sas-schatzi
    sas-schatzi Member Posts: 19,603
    edited December 2015

    Loverly, well that's nice. Great lists.

    Hi Grammy, Falleaves will likely be along. She's the resident expert on the opiod studies and relationship to recurrence. Maybe not tonight LOL. But soon. I'll send her a PM.

    Here's her list of threads. She's been a busy woman. More studying. It'll be like you were back in college.

    Links to BCO threads that are related to this topic:

    Topic: Paravertebral Nerve Block and Propofol Sept. 2015, by Falleaves

    https://community.breastcancer.org/forum/73/topic/834546?page=1#idx_15

    Topic: Effects of opioids on cancer progression Sept. 2015, by Falleaves

    https://community.breastcancer.org/forum/73/topic/835291?page=1#idx_

    Topic: ketorolac to reduce recurrence Mar. 2014, by Falleaves

    https://community.breastcancer.org/forum/91/topic/818961?page=1#post_3936891

    Topic: Anesthesia and recurrence of cancer Sept. 2015, by Fallleaves

    https://community.breastcancer.org/forum/73/topic/835244

    · Share on FacebookShare on Twitter
  • sas-schatzi
    sas-schatzi Member Posts: 19,603
    edited December 2015

    Done......Pm'd Falls.

    · Share on FacebookShare on Twitter
  • sas-schatzi
    sas-schatzi Member Posts: 19,603
    edited January 2016

    image

    · Share on FacebookShare on Twitter

Categories