[Evaluation of regional analgesia and surgical trauma on selected factors of the human immune system].
The work attempted to explain the influence of epidural analgesia and operations on the behaviour of complement and lymphocyte systems. There are very few theses in the world anaesthetic literature which attempt to explain the influence of analgesia and operations on the immune system. Moreover, the problem is treated very superficially in these theses and research was conducted on a small number of patients. In the face of this fact it was decided to assess the behaviour of selected factors of the immune system during analgesia and operations. The research encompassed approximately 80 patients who underwent analgesia and operations. The operated patients were divided into two groups: a 40-person research group A and a 40-person control group K. In group A resection of the prostate gland was performed in epidural analgesia, whereas group K underwent analgesia of the brachial plexus to be operated within the hand and the upper limb. Because of the small extent of sympathetic interruption and of the operation the K group was the control group in relation to the A group where the sympathetic interruption and the operation were extensive. During the analgesia, operation and the 7-day post-operation period the concentration of immunoglobulins was examined (IgG, IgA, IgM), components of the complement (C3, C4), the total haemolithic activity of the complement (Kc) as well lymphocyte populations and sub-populations (B, T, CD4, CD8). Modern research techniques were used to carry out these examinations: monoclone antibody for examining lymphocytes, nephelometric technique for examining concentration of immunoglobulins and components of the complement and the hemolithic method for examination of the total activity of the complement. It was found that epidural analgesia acts deeply depressively on the concentration of endogenous immunoglobulins and of the components of the complement during the day of the operation. This type of analgesia also a similar effect on the level of total haemolithic activity of the complement. Operation trauma on the other hand causes depression of the auxiliary T lymphocyte population (CD4) and the stimulation of the cytotoxic T cell subpopulation (CD8) with a pathological reduction of the quotient factor of these lymphocyte sub-populations CD4/CD8. No statistically significant immunologic disorders were found in the area of the factors examined in patients who underwent operations in the area of the hand and the upper limb with application of plexus analgesia. The presented research results--although they do not have a correspondent in the world anaesthetic literature--seem to prove that epidural analgesia, hitherto regarded as a safe manner of anaesthetizing patients for operations is not devoid of negative influences on the immune system. With regard to immunity on the other hand, plexus analgesia seems to be a safe method anaesthetizing patients for operations in the area of the upper limb. It seems that the extent of sympathetic interruption caused by epidural analgesia affects selected immune factors depressively. This is a clinical question which still requires much research, especially in the area of effect on the immune system because post operative infection complications still constitute an important etiopathogenetic and medical problem.
Gajdosz
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Kliniczny Oddział Anestezjologii i Intensywnej Terapii 5 Wojskowego Szpitala Klinicznego w Krakowie.
D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural / Q000009:adverse effects*; D000775:Anesthesia, Spinal / Q000009:adverse effects; D001917:Brachial Plexus; D016516:CD4-CD8 Ratio; D003165:Complement System Proteins / Q000276:immunology; D006225:Hand / Q000601:surgery; D006801:Humans; D007136:Immunoglobulins / Q000276:immunology*; D016131:Lymphocyte Subsets / Q000276:immunology; D008214:Lymphocytes / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000601:surgery; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D013601:T-Lymphocytes / Q000276:immunology
D007136:Immunoglobulins; D003165:Complement System Proteins