The effects of continuous epidural anesthesia and analgesia on stress response and immune function in patients undergoing radical esophagectomy.
We investigated whether perioperative extensive epidural block (C3-L) affects postoperative immune response in patients undergoing radical esophagectomy. Patients undergoing radical esophagectomy were randomly assigned to either general anesthesia with continuous epidural infusion via 2 epidural catheters that was continued for postoperative analgesia (group E, n = 15) or intraoperative general anesthesia and postoperative IV morphine analgesia (group G, n = 15). Plasma levels of stress hormones, cytokines, C-reactive protein (CRP), leukocyte counts, and distribution of lymphocyte subsets were assessed before and after surgery and on postoperative days (PODs) 1 and 3. In comparison with group E, significant increases in plasma epinephrine level at the end of surgery (P < 0.05) and norepinephrine level at the end of surgery (P < 0.01) and on POD1 (P < 0.01) and POD3 (P < 0.01) and significant decrease in cluster of differentiation (CD4/CD8 ratio) at the end of surgery (P < 0.05) were observed in group G. However, there were no significant differences in other variables between groups. In both groups, plasma cortisol, adrenocorticotropic hormone, interleukin (IL)-1beta, IL-6, IL-10, and CRP levels were increased after surgery (each group P < 0.01) and IL-1beta, IL-6, IL-10, and CRP were still increased on POD1 and POD3 (each change, each group P < 0.01). Leukocyte counts were increased on POD1 (each group P < 0.05) and POD3 (each group P < 0.01). The proportion of lymphocytes decreased from the end of surgery to POD3 (each group P < 0.01). The proportion of B cells was increased on POD1 (each group P < 0.01); that of natural killer cells was decreased at POD1 and POD3 (each group P < 0.01). We conclude that tissue damage and inflammation apparently overcome the effects of extensive epidural block on stress response and immune function in radical esophagectomy.
Yokoyama
Masataka
M
Department of Anesthesiology and Resuscitology Okayama University Medical School 2-5-1, Shikata-cho, Okayama City, Okayama 700-8558, Japan.
Itano
Yoshitaro
Y
Katayama
Hiroshi
H
Morimatsu
Hiroshi
H
Takeda
Yoshimasa
Y
Takahashi
Toru
T
Nagano
Osamu
O
Morita
Kiyoshi
K
D000368:Aged; D015360:Analgesia, Epidural; D000767:Anesthesia, Epidural; D002097:C-Reactive Protein / Q000032:analysis; D016207:Cytokines / Q000097:blood; D004837:Epinephrine / Q000097:blood; D016629:Esophagectomy; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D013315:Stress, Psychological / Q000209:etiology*
D016207:Cytokines; D002097:C-Reactive Protein; D006854:Hydrocortisone; D004837:Epinephrine