title: Intraoperative epidural analgesia prevents the early proinflammatory response to surgical trauma. Results from a prospective randomized clinical trial of intraoperative epidural versus general analgesia.
abstract: BACKGROUND
  The intraoperative epidural analgesia (EA) has the potential to reduce stress response to surgical trauma which induces a transient immunoactivation that has a negative impact on the outcome. This study investigates the effect of intraoperative EA versus intravenous analgesia (IA) on the immune function.
  
  
  METHODS
  A total of 35 consecutive patients candidated to undergo major surgery for colon cancer were randomly assigned to intraoperative EA (n = 18) or IA (n = 17). Blood samples for TNF-α, IFN-γ, IL-1, IL-2, IL-4, IL-6, IL-10, IL-12, and GM-CSF were obtained before surgery (T(pre)), 3 h (T(3h)), and 24 h (T(24h)) after skin incision. Data on postoperative complications were prospectively collected and analyzed.
  
  
  RESULTS
  In the EA group, IL-4 increased from T(pre) to T(3h) and from T(3h) to T(24h), IL-10 increased from T(pre) to T(3h) and persisted unmodified thereafter. At all time-points, IL-4 and IL-10 serum levels were significantly higher than those in the IA group. Conversely, in the IA group, IL-4 and IL-10 serum levels did not change while all other cytokines levels were significantly higher compared with the EA group. In particular, IL-6 progressively reached a 7-fold increase of its basal value at T(24h). Complications were significantly more common in IA patients (13 of 17) compared with EA patients (7 of 18) (P = .024).
  
  
  CONCLUSIONS
  Our results indicate that in cancer patients undergoing major elective colon surgery, the EA attenuates the surgery-induced proinflammatory response and the typical postoperative transient immunosuppression and seems associated with a reduced rate of postoperative complications compared with IA.
authors.affiliation: Department of Anesthesiology, Intensive Care and Pain Therapy, IRCC-Institute for Cancer Research and Treatment, Candiolo, Italy.
authors.forename: Nora Maria
authors.initials: NM
authors.lastname: Moselli
authors.forename: Elisa
authors.initials: E
authors.lastname: Baricocchi
authors.forename: Dario
authors.initials: D
authors.lastname: Ribero
authors.forename: Antonio
authors.initials: A
authors.lastname: Sottile
authors.forename: Luisa
authors.initials: L
authors.lastname: Suita
authors.forename: Felicino
authors.initials: F
authors.lastname: Debernardi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia / Q000706:statistics & numerical data*; D015360:Analgesia, Epidural / Q000706:statistics & numerical data*; D000700:Analgesics / Q000627:therapeutic use; D003110:Colonic Neoplasms / Q000150:complications / Q000276:immunology* / Q000601:surgery*; D016207:Cytokines / Q000378:metabolism; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000378:metabolism*; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000209:etiology / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000700:Analgesics; D016207:Cytokines; D018836:Inflammation Mediators