title: Pre-emptive epidural analgesia improves post-operative pain and immune function in patients undergoing thoracotomy.
abstract: BACKGROUND
  Pre-emptive analgesia may relieve post-operative pain. However, its effects on immune function of patients undergoing thoracotomy are still unclear. Therefore, we investigated effects of pre-emptive epidural analgesia on post-operative pain and immune function in patients undergoing thoracotomy.
  
  
  METHODS
  Ninety patients undergoing thoracotomy were randomized equally into three groups. Group A (control) only received patient-controlled epidural analgesia (PCEA). Group B (routine) was given 0.125% ropivacaine 6 mL 30 min after surgery, then PCEA. Group C (pre-emptive) received 0.125% ropivacaine 6 mL 30 min before skin incision and every 60 min during surgery, then PCEA. Visual analogue scale scores and cytokine levels were the main outcomes. Secondary outcomes included analgesic demands, side effects and hospital stays.
  
  
  RESULTS
  Post-operative visual analogue scale scores were decreased in group C compared with group B, and that of group B were lower than in group A (P < 0.05). Compared with group B, protein and mRNA expressions of tumour necrosis factor-α, interleukin (IL)-6 and IL-8 were decreased, and that of IL-4 were increased in group C (P = 0.002∼0.049). Both analgesic demands and the incidences of nausea/vomiting and hypotension were lower in group C compared with group B (P = 0.01∼0.037). Hospital stays were shorter in group C compared with group B (P = 0.045).
  
  
  CONCLUSIONS
  These findings suggest that pre-emptive epidural analgesia can produce better analgesia effects, with less analgesic demands and side effects, and attenuate the surgery-induced immune alterations, and improve the post-operative recovery in patients undergoing thoracotomy.
authors.affiliation: Department of Anesthesiology, The First Affiliated Hospital, Harbin Medical University, Harbin, China.
authors.forename: Chengzhi
authors.initials: C
authors.lastname: Yang
authors.affiliation: Department of Thoracic Surgery, The First Affiliated Hospital, Harbin Medical University, Harbin, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Chang
authors.affiliation: Department of Thoracic Surgery, The First Affiliated Hospital, Harbin Medical University, Harbin, China.
authors.forename: Tiewa
authors.initials: T
authors.lastname: Zhang
authors.affiliation: Department of Pathology, The First Affiliated Hospital, Harbin Medical University, Harbin, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Liang
authors.affiliation: Department of Anesthesiology, The First Affiliated Hospital, Harbin Medical University, Harbin, China.
authors.forename: Enyou
authors.initials: E
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D000577:Amides / Q000494:pharmacology / Q000627:therapeutic use*; D015360:Analgesia, Epidural / Q000379:methods*; D016058:Analgesia, Patient-Controlled / Q000379:methods; D000700:Analgesics / Q000494:pharmacology / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D016207:Cytokines / Q000097:blood; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007107:Immune System / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000517:prevention & control*; D019990:Perioperative Care / Q000379:methods*; D000077212:Ropivacaine; D013908:Thoracotomy
chemical_list: D000577:Amides; D000700:Analgesics; D015415:Biomarkers; D016207:Cytokines; D000077212:Ropivacaine
keywords: PECA; immune function; pain; pre-emptive analgesia; thoracotomy