title: Selective neurogenic blockade and perioperative immune reactivity in patients undergoing lung resection.
abstract: OBJECTIVE
  This double-blind, prospective, randomized, controlled trial examined the effects of thoracic epidural block and intravenous clonidine and opioid treatment on the postoperative Th1/Th2 cytokine ratio after lung surgery. The primary endpoint was the interferon γ (IFN-γ; Th1 cytokine)/interleukin 4 (IL-4; Th2 cytokine) ratio. Secondary endpoints were reductions in pain and incidence of pneumonia.
  
  
  METHODS
  Sixty patients were randomized into three groups to receive remifentanil intravenously (remifentanil group, n=20), remifentanil and clonidine intravenously (clonidine group, n=20), or ropivacaine epidurally (ropivacaine group, n=20). Pain was assessed using a numerical rating scale (NRS). Cytokines were measured using a cytometric bead array.
  
  
  RESULTS
  Patients in the ropivacaine group (thoracic epidural block) had a significantly lower IFN-γ/IL-4 ratio at the end of surgery than those in the remifentanil group and clonidine group. There were no significant between-group differences in the IFN-γ/IL-4 ratio at other time-points. There were no differences in NRS scores at any time-point. No patient developed pneumonia.
  
  
  CONCLUSIONS
  Intraoperative thoracic epidural block decreased the IFN-γ/IL-4 ratio immediately after lung surgery, indicating less inflammatory stimulation during surgery.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine Unit, Charité-University Hospital Berlin, Berlin, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Viviano
authors.forename: M
authors.initials: M
authors.lastname: Renius
authors.forename: J-C
authors.initials: JC
authors.lastname: Rückert
authors.forename: A
authors.initials: A
authors.lastname: Bloch
authors.forename: C
authors.initials: C
authors.lastname: Meisel
authors.forename: A
authors.initials: A
authors.lastname: Harbeck-Seu
authors.forename: W
authors.initials: W
authors.lastname: Boemke
authors.forename: M
authors.initials: M
authors.lastname: Hensel
authors.forename: K-D
authors.initials: KD
authors.lastname: Wernecke
authors.forename: C
authors.initials: C
authors.lastname: Spies
mesh_terms: D000368:Aged; D000577:Amides / Q000008:administration & dosage / Q000494:pharmacology; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000494:pharmacology; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000494:pharmacology; D003000:Clonidine / Q000008:administration & dosage / Q000494:pharmacology; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007268:Injections, Epidural; D007275:Injections, Intravenous; D007371:Interferon-gamma / Q000378:metabolism; D015847:Interleukin-4 / Q000378:metabolism; D008168:Lung / Q000276:immunology* / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D010147:Pain Measurement; D019990:Perioperative Care; D010880:Piperidines / Q000008:administration & dosage / Q000494:pharmacology; D000077208:Remifentanil; D000077212:Ropivacaine; D016896:Treatment Outcome
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D010880:Piperidines; D015847:Interleukin-4; D000077212:Ropivacaine; D007371:Interferon-gamma; D003000:Clonidine; D000077208:Remifentanil