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 language | English |
|---|---|
| Pages (from-to) | 2722-2731 |
| Number of pages | 10 |
| Journal | Annals of Surgical Oncology |
| Volume | 18 |
| Issue number | 10 |
| DOIs | |
| Publication status | Published - Oct 2011 |
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ASJC Scopus subject areas
- Surgery
- Oncology
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Intraoperative epidural analgesia prevents the early proinflammatory response to surgical trauma. Results from a prospective randomized clinical trial of intraoperative epidural versus general analgesia. / Moselli, Nora Maria; Baricocchi, Elisa; Ribero, Dario; Sottile, Antonio; Suita, Luisa; Debernardi, Felicino.
In: Annals of Surgical Oncology, Vol. 18, No. 10, 10.2011, p. 2722-2731.Research output: Contribution to journal › Article
}
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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UR - http://www.scopus.com/inward/citedby.url?scp=80052748303&partnerID=8YFLogxK
U2 - 10.1245/s10434-011-1700-9
DO - 10.1245/s10434-011-1700-9
M3 - Article
C2 - 21479690
AN - SCOPUS:80052748303
VL - 18
SP - 2722
EP - 2731
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
SN - 1068-9265
IS - 10
ER -