Effects of post-operative pain treatment using non-steroidal anti-inflammatory analgesics, opioids or epidural blockade on systemic and local immune responses in children.
BACKGROUND
Many studies have been carried out on the effects of anaesthetic drugs and methods on the immune response, but pain and its relief also affect the immune response. We measured systemic immune responses in the blood circulation and local responses in the surgical wound when non-steroidal anti-inflammatory analgesics (NSAIDs), opioids or epidural blockade was used in the peri-operative treatment of pain.


METHODS
Responses were measured in 51 children, aged from 2 to 12 years and undergoing major surgery under balanced anaesthesia. Bolus doses of diclofenac intravenously (i.v.) and rectally (NSAID group), continuous i.v. infusion of oxycodone (opioid group) or continuous epidural infusion of bupivacaine + fentanyl (epidural group) were used peri-operatively for pain relief.


RESULTS
The only difference related to the analgesic method was shorter duration of post-operative leucocytosis and lower phytohaemagglutinin (PHA)-induced lymphocyte proliferative responses in peripheral blood in the opioid group than in the NSAID or epidural groups. By contrast, time-related alterations were seen overall in leucocyte and differential counts, lymphocyte and their subset counts, lymphocyte proliferative responses, and in serum cortisol, C-reactive protein, plasma interleukin-6 and group II phospholipase A2 concentrations and in the appearance of different cell types in the wound.


CONCLUSIONS
Post-operative pain treatments using diclofenac (NSAID), oxycodone (opioid) and epidural blockade have basically similar effects on systemic and local immune responses with only slight, probably clinically unimportant differences in children undergoing surgery under general anaesthesia.
Vuori
A
A
Department of Anesthesia, Loimaa Regional Hospital, Loimaa, Finland. matti.salo@luukku.com
Salo
M
M
Viljanto
J
J
Pajulo
O
O
Pulkki
K
K
Nevalainen
T
T
D015360:Analgesia, Epidural / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000276:immunology / Q000627:therapeutic use*; D000704:Analysis of Variance; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000276:immunology / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000276:immunology / Q000627:therapeutic use*; D002045:Bupivacaine / Q000008:administration & dosage / Q000276:immunology / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004008:Diclofenac / Q000008:administration & dosage / Q000276:immunology / Q000627:therapeutic use; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000276:immunology / Q000627:therapeutic use; D005387:Finland; D006801:Humans; D007111:Immunity, Cellular / Q000187:drug effects* / Q000502:physiology; D007958:Leukocyte Count; D008297:Male; D010098:Oxycodone / Q000008:administration & dosage / Q000276:immunology / Q000627:therapeutic use; D010149:Postoperative Pain / Q000188:drug therapy* / Q000276:immunology
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac; D010098:Oxycodone; D005283:Fentanyl; D002045:Bupivacaine