Intraoperative epidural analgesia prevents the early proinflammatory response to surgical trauma. Results from a prospective randomized clinical trial of intraoperative epidural versus general analgesia

Nora Maria Moselli, Elisa Baricocchi, Dario Ribero, Antonio Sottile, Luisa Suita, Felicino Debernardi

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Abstract

Background: The intraoperative epidural analgesia (EA) has the potential to reduce stress response to surgical trauma which induces a transient immunoactivation that has a negative impact on the outcome. This study investigates the effect of intraoperative EA versus intravenous analgesia (IA) on the immune function. Methods: A total of 35 consecutive patients candidated to undergo major surgery for colon cancer were randomly assigned to intraoperative EA (n = 18) or IA (n = 17). Blood samples for TNF-α, IFN-γ, IL-1, IL-2, IL-4, IL-6, IL-10, IL-12, and GM-CSF were obtained before surgery (T pre), 3 h (T 3h), and 24 h (T 24h) after skin incision. Data on postoperative complications were prospectively collected and analyzed. Results: In the EA group, IL-4 increased from T pre to T 3h and from T 3h to T 24h, IL-10 increased from T pre to T 3h and persisted unmodified thereafter. At all time-points, IL-4 and IL-10 serum levels were significantly higher than those in the IA group. Conversely, in the IA group, IL-4 and IL-10 serum levels did not change while all other cytokines levels were significantly higher compared with the EA group. In particular, IL-6 progressively reached a 7-fold increase of its basal value at T 24h. Complications were significantly more common in IA patients (13 of 17) compared with EA patients (7 of 18) (P = .024). Conclusions: Our results indicate that in cancer patients undergoing major elective colon surgery, the EA attenuates the surgery-induced proinflammatory response and the typical postoperative transient immunosuppression and seems associated with a reduced rate of postoperative complications compared with IA.

Original languageEnglish
Pages (from-to)2722-2731
Number of pages10
JournalAnnals of Surgical Oncology
Volume18
Issue number10
DOIs
Publication statusPublished - Oct 2011

Fingerprint

Epidural Analgesia
Analgesia
Randomized Controlled Trials
Wounds and Injuries
Interleukin-4
Interleukin-10
Interleukin-6
Interleukin-12
Granulocyte-Macrophage Colony-Stimulating Factor
Serum
Interleukin-1
Colonic Neoplasms
Immunosuppression
Interleukin-2
Colon
Cytokines
Skin
Neoplasms

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

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title = "Intraoperative epidural analgesia prevents the early proinflammatory response to surgical trauma. Results from a prospective randomized clinical trial of intraoperative epidural versus general analgesia",
abstract = "Background: The intraoperative epidural analgesia (EA) has the potential to reduce stress response to surgical trauma which induces a transient immunoactivation that has a negative impact on the outcome. This study investigates the effect of intraoperative EA versus intravenous analgesia (IA) on the immune function. Methods: A total of 35 consecutive patients candidated to undergo major surgery for colon cancer were randomly assigned to intraoperative EA (n = 18) or IA (n = 17). Blood samples for TNF-α, IFN-γ, IL-1, IL-2, IL-4, IL-6, IL-10, IL-12, and GM-CSF were obtained before surgery (T pre), 3 h (T 3h), and 24 h (T 24h) after skin incision. Data on postoperative complications were prospectively collected and analyzed. Results: In the EA group, IL-4 increased from T pre to T 3h and from T 3h to T 24h, IL-10 increased from T pre to T 3h and persisted unmodified thereafter. At all time-points, IL-4 and IL-10 serum levels were significantly higher than those in the IA group. Conversely, in the IA group, IL-4 and IL-10 serum levels did not change while all other cytokines levels were significantly higher compared with the EA group. In particular, IL-6 progressively reached a 7-fold increase of its basal value at T 24h. Complications were significantly more common in IA patients (13 of 17) compared with EA patients (7 of 18) (P = .024). Conclusions: Our results indicate that in cancer patients undergoing major elective colon surgery, the EA attenuates the surgery-induced proinflammatory response and the typical postoperative transient immunosuppression and seems associated with a reduced rate of postoperative complications compared with IA.",
author = "Moselli, {Nora Maria} and Elisa Baricocchi and Dario Ribero and Antonio Sottile and Luisa Suita and Felicino Debernardi",
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TY - JOUR

T1 - Intraoperative epidural analgesia prevents the early proinflammatory response to surgical trauma. Results from a prospective randomized clinical trial of intraoperative epidural versus general analgesia

AU - Moselli, Nora Maria

AU - Baricocchi, Elisa

AU - Ribero, Dario

AU - Sottile, Antonio

AU - Suita, Luisa

AU - Debernardi, Felicino

PY - 2011/10

Y1 - 2011/10

N2 - Background: The intraoperative epidural analgesia (EA) has the potential to reduce stress response to surgical trauma which induces a transient immunoactivation that has a negative impact on the outcome. This study investigates the effect of intraoperative EA versus intravenous analgesia (IA) on the immune function. Methods: A total of 35 consecutive patients candidated to undergo major surgery for colon cancer were randomly assigned to intraoperative EA (n = 18) or IA (n = 17). Blood samples for TNF-α, IFN-γ, IL-1, IL-2, IL-4, IL-6, IL-10, IL-12, and GM-CSF were obtained before surgery (T pre), 3 h (T 3h), and 24 h (T 24h) after skin incision. Data on postoperative complications were prospectively collected and analyzed. Results: In the EA group, IL-4 increased from T pre to T 3h and from T 3h to T 24h, IL-10 increased from T pre to T 3h and persisted unmodified thereafter. At all time-points, IL-4 and IL-10 serum levels were significantly higher than those in the IA group. Conversely, in the IA group, IL-4 and IL-10 serum levels did not change while all other cytokines levels were significantly higher compared with the EA group. In particular, IL-6 progressively reached a 7-fold increase of its basal value at T 24h. Complications were significantly more common in IA patients (13 of 17) compared with EA patients (7 of 18) (P = .024). Conclusions: Our results indicate that in cancer patients undergoing major elective colon surgery, the EA attenuates the surgery-induced proinflammatory response and the typical postoperative transient immunosuppression and seems associated with a reduced rate of postoperative complications compared with IA.

AB - Background: The intraoperative epidural analgesia (EA) has the potential to reduce stress response to surgical trauma which induces a transient immunoactivation that has a negative impact on the outcome. This study investigates the effect of intraoperative EA versus intravenous analgesia (IA) on the immune function. Methods: A total of 35 consecutive patients candidated to undergo major surgery for colon cancer were randomly assigned to intraoperative EA (n = 18) or IA (n = 17). Blood samples for TNF-α, IFN-γ, IL-1, IL-2, IL-4, IL-6, IL-10, IL-12, and GM-CSF were obtained before surgery (T pre), 3 h (T 3h), and 24 h (T 24h) after skin incision. Data on postoperative complications were prospectively collected and analyzed. Results: In the EA group, IL-4 increased from T pre to T 3h and from T 3h to T 24h, IL-10 increased from T pre to T 3h and persisted unmodified thereafter. At all time-points, IL-4 and IL-10 serum levels were significantly higher than those in the IA group. Conversely, in the IA group, IL-4 and IL-10 serum levels did not change while all other cytokines levels were significantly higher compared with the EA group. In particular, IL-6 progressively reached a 7-fold increase of its basal value at T 24h. Complications were significantly more common in IA patients (13 of 17) compared with EA patients (7 of 18) (P = .024). Conclusions: Our results indicate that in cancer patients undergoing major elective colon surgery, the EA attenuates the surgery-induced proinflammatory response and the typical postoperative transient immunosuppression and seems associated with a reduced rate of postoperative complications compared with IA.

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U2 - 10.1245/s10434-011-1700-9

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JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

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