title: Effect of preemptive epidural analgesia on cytokine response and postoperative pain in laparoscopic radical hysterectomy for cervical cancer.
abstract: OBJECTIVE
  Surgical stress and general anesthesia suppress immune function. Preemptive epidural analgesia can affect the perioperative immune responses, and influence cancer management.
  
  
  METHODS
  Forty women undergoing elective laparoscopic radical hysterectomy for cervical cancer were allocated to this prospective, randomized, double-blind trial. Before inducing anesthesia, 2 mg morphine dissolved in 15 mL of 1% lidocaine (preemptive group) or the same volume of normal saline (control group) was administered into the epidural space through a prepared catheter in a double-blind manner, using sealed syringes. After peritoneal closure, the other drugs in the remaining sealed syringe were administered in the reverse manner. All patients were then administered lidocaine plus morphine over a 72-hour period, using a patient-controlled epidural analgesia pump.
  
  
  RESULTS
  The interleukin-6 levels in both groups increased significantly after surgery. These elevations were significantly less pronounced in the preemptive group than in the control group. The interleukin-2 level in both groups decreased significantly after surgery. Seventy-two hours after surgery, the interleukin-2 level returned to its baseline value in the preemptive group but not in the control group. The number of lymphocytes in both groups decreased significantly after surgery. The pain scores at 6 and 12 hours after surgery in the preemptive group were significantly lower than in the control group.
  
  
  CONCLUSIONS
  Preemptive epidural analgesia is a reasonable approach for potentially controlling perioperative immune function and preventing postoperative pain in patients undergoing cancer surgery.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea. jenyhongg@hanmail.net
authors.forename: Jeong-Yeon
authors.initials: JY
authors.lastname: Hong
authors.forename: Kyung T
authors.initials: KT
authors.lastname: Lim
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000379:methods; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000768:Anesthesia, General; D000779:Anesthetics, Local / Q000008:administration & dosage; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007045:Hysterectomy, Vaginal; D007376:Interleukin-2 / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood*; D007432:Intraoperative Period; D010535:Laparoscopy; D007958:Leukocyte Count; D008012:Lidocaine / Q000008:administration & dosage; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D010147:Pain Measurement; D010149:Postoperative Pain / Q000276:immunology* / Q000517:prevention & control*; D011300:Preoperative Care; D011446:Prospective Studies; D013312:Stress, Physiological / Q000276:immunology*; D002583:Uterine Cervical Neoplasms / Q000276:immunology* / Q000601:surgery*
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D007376:Interleukin-2; D015850:Interleukin-6; D009020:Morphine; D008012:Lidocaine