الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Breast cancer is a widespread health problem, with more than 2 million new cases worldwide. The neuroendocrine stress response associated with surgery, anaesthetics, and opioid analgesics are factors that adversely affect the immune defense against tumors. Perioperative intervention can affect the recurrence of the tumor or metastasis by affecting tumor cell signals, immune response, and neuroendocrine stress response.
The intraoperative administration of opioids was considered the cornerstone of anaesthesia. Synthetic opioids were given to stabilize the haemodynamics during anaesthesia. They can inhibit the sympathetic nervous system without causing cardiovascular depression and histamine release. Despite their benefits, opioids are experiencing more and more adverse side effects, which can cause significant morbidity and mortality, as respiratory depression, nausea/vomiting, constipation, tolerance and hyperalgesia
Opioid free multimodal analgesia has become an alternative to postoperative pain relief. The use of multimodal non-opioid analgesics during the perioperative period can preventively block receptors in complex pain pathways. It has been shown that preoperative use of Cox inhibitors, GABA agonist and paracetamol can reduce postoperative opioid consumption. Sodium channel block, G protein related receptor block, NMDA receptor antagonist, central alpha-2 agonist, and nonsteroidal anti-inflammatory drugs (NSAIDs) may lead to opioid free anaesthesia (OFA). Thoracic paravertebral block (TPVB) combined with general anaesthesia (GA) can provide excellent analgesia for cancer surgery and reduce the severity of chronic pain after mastectomy.
The immune system has a major role in preventing cancer development and prevent its metastasis. The acute and chronic administration of exogenous opioids appear to affect the body’s cell mediated and humoral immune response. Exogenous opioids have a significant effect on several components of the immune system including lymphocyte proliferation., phagocytic activity, natural killer cell activity, cytokine expression and antibody production.