title: Painful regional anaesthesia induces an immunological stress reaction: the model of retrobulbar anaesthesia.
abstract: OBJECTIVE
  Laboratory stress studies found that acute psychological stresses may elicit changes in leukocyte numbers similar to those occurring in physical stresses. Both types of stress evoke - mainly by release of catecholamines - leukocytosis resulting from a release of natural killer cells (NK-cells), of CD8+ T-cells, of monocytes and of neutrophils. However, there is little proof that laboratory stress models can be applied to daily clinical routines. As a likely inductor of an immunological stress response the setting of retrobulbar anaesthesia prior to intraocular surgery permits the study of a short-term painful anaesthetic procedure under highly standardized conditions. This was examined in 16 female patients.
  
  
  METHODS
  Counts of leukocyte subsets, serum cortisol and cardiovascular variables were measured 30 min and 1 min prior to retrobulbar anaesthesia as well as 2, 15 and 45 min afterwards.
  
  
  RESULTS
  The setting of retrobulbar anaesthesia induced an increase in total leukocytes [+380 cells microL-1; P < 0.01 (means; significance level)] mainly due to rising counts of neutrophils (+241 cells microL-1, P < 0.01). Of all lymphocyte subpopulations, natural killer cells increased most markedly (+64 cells microL-1; P < 0.01). Furthermore, the retrobulbar block induced an increase in systolic arterial pressure (+15.2 mmHg; P < 0.01).
  
  
  CONCLUSIONS
  These changes in immunological and cardiovascular variables are considered to be elements of a sympatho-adrenal stress reaction; catecholamines are considered to induce a demargination of leukocytes by binding to beta2-adrenoceptors and by modifying the avidity state of adhesion molecules.
authors.affiliation: Department of Nephrology, University of Saarland, 66421 Homburg, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Heine
authors.forename: H
authors.initials: H
authors.lastname: Gabriel
authors.forename: J
authors.initials: J
authors.lastname: Weindler
authors.forename: K W
authors.initials: KW
authors.lastname: Ruprecht
authors.forename: W
authors.initials: W
authors.lastname: Kindermann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000765:Anesthesia, Conduction / Q000009:adverse effects* / Q000379:methods; D002045:Bupivacaine; D002355:Carticaine; D002395:Catecholamines / Q000097:blood; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007267:Injections; D007958:Leukocyte Count; D007964:Leukocytosis / Q000097:blood / Q000209:etiology*; D016131:Lymphocyte Subsets; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D010146:Pain / Q000209:etiology / Q000276:immunology*; D018709:Statistics, Nonparametric; D013312:Stress, Physiological / Q000209:etiology* / Q000276:immunology / Q000523:psychology
chemical_list: D002395:Catecholamines; D002355:Carticaine; D002045:Bupivacaine