title: Effects of Postoperative Pain Management on Immune Function After Laparoscopic Resection of Colorectal Cancer: A Randomized Study.
abstract: There has been a rising interest in the possible association between perioperative opioid use and postoperative outcomes in cancer patients. Continuous surgical wound infiltration with local anesthetics is a nonopioid analgesic technique that can be used as a postoperative pain management alternative to opioid-based intravenous patient-controlled analgesia (IV PCA). The aim of this study was to compare the effects of an opioid-based analgesic regimen versus a local anesthetic wound infiltration-based analgesic regimen on immune modulation and short-term cancer recurrence or metastasis in patients undergoing laparoscopic resection of colorectal cancer.Sixty patients undergoing laparoscopic resection of colorectal cancer were randomly assigned to either the opioid group or the ON-Q group. For postoperative analgesia during the first 48 hours, the opioid group (n = 30) received fentanyl via IV PCA, whereas the ON-Q group (n = 30) received continuous wound infiltration of 0.5% ropivacaine with an ON-Q pump and tramadol via IV PCA. Pethidine for the opioid group and ketorolac or propacetamol for the ON-Q group were used as rescue analgesics. Anesthesia was induced and maintained with propofol and remifentanil. The primary outcome was postoperative immune function assessed by natural killer cell cytotoxicity (NKCC) and interleukin-2. Secondary outcomes were postoperative complications, cancer recurrence, or metastasis within 1 year after surgery, and postoperative inflammatory responses measured by white blood cell count, neutrophil percentage, and C-reactive protein. Immune function and inflammatory responses were measured before surgery and 24 and 48 hours after surgery.Fifty-nine patients completed the study. In the circumstance of similar pain control efficacy between the opioid group and the ON-Q group, postoperative NKCC and interleukin-2 levels did not differ between the 2 groups. The incidence of postoperative complications and recurrence or metastasis within 1 year after surgery was comparable between the groups. Postoperative inflammatory responses were also similar between the groups.When compared with ropivacaine wound infiltration-based analgesia, fentanyl-based analgesia did not further decrease NKCC or affect short-term cancer recurrence or metastasis. Thus, a fentanyl-based analgesic regimen and a ropivacaine wound infiltration-based analgesic regimen can both be used for postoperative pain management in laparoscopic resection of colorectal cancer.
authors.affiliation: From the Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine (SYK, H-YN, B-NK); Department of Surgery, Division of Colon and Rectal Surgery, Yonsei University College of Medicine (NKK, SHB, BSM, HH); Biostatistics Collaboration Unit, Yonsei University College of Medicine (JL); and Research Center for Silver Science, Institute of Symbiotic Life-TECH, National Leading Research Laboratory of Clinical Nutrigenetics/Nutrigenomics, Department of Food and Nutrition, Brain Korea 21 PLUS Project, College of Human Ecology, Yonsei University (JHL), Seoul, Republic of Korea.
authors.forename: So Yeon
authors.initials: SY
authors.lastname: Kim
authors.forename: Nam Kyu
authors.initials: NK
authors.lastname: Kim
authors.forename: Seung Hyuk
authors.initials: SH
authors.lastname: Baik
authors.forename: Byung Soh
authors.initials: BS
authors.lastname: Min
authors.forename: Hyuk
authors.initials: H
authors.lastname: Hur
authors.forename: Jinae
authors.initials: J
authors.lastname: Lee
authors.forename: Hyun-Young
authors.initials: HY
authors.lastname: Noh
authors.forename: Jong Ho
authors.initials: JH
authors.lastname: Lee
authors.forename: Bon-Nyeo
authors.initials: BN
authors.lastname: Koo
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000577:Amides / Q000008:administration & dosage; D016058:Analgesia, Patient-Controlled / Q000379:methods; D000701:Analgesics, Opioid / Q000494:pharmacology*; D000779:Anesthetics, Local / Q000008:administration & dosage; D003082:Colectomy / Q000009:adverse effects / Q000379:methods; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D003602:Cytotoxicity, Immunologic / Q000187:drug effects*; D004359:Drug Therapy, Combination; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D007694:Killer Cells, Natural / Q000276:immunology; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology; D059408:Pain Management / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy*; D011184:Postoperative Period; D000077212:Ropivacaine; D014147:Tramadol / Q000008:administration & dosage
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D014147:Tramadol; D000077212:Ropivacaine; D005283:Fentanyl