title: Effects of combined general anesthesia and thoracic epidural analgesia on cytokine response in patients undergoing laparoscopic cholecystectomy.
abstract: BACKGROUND
  Severe postoperative pain is not often experienced in laparoscopic cholecystectomy. Anesthesia, surgery, and pain are stressful and cause different reactions in neuro-immuno-endocrine systems. Many factors such as the pharmacological effect of the drugs used, as well as the type and depth of anesthesia, can affect these reactions.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the effect of the combination of general anesthesia and thoracic epidural analgesia (TEA) on cytokine reaction in laparoscopic cholecystectomy.
  
  
  METHODS
  Prospective, randomized clinical comparative study.
  
  
  METHODS
  Sixty adult patients scheduled for elective laparoscopic cholecystectomy were divided into four groups. Group saline (Group S), group fentanyl (Group F), group bupivacaine (Group B), and group levobupivacaine (Group L) were infused with saline, saline and fentanyl, bupivacaine and fentanyl, and levobupivacaine and fentanyl, respectively, via epidural catheter before surgical incision.
  
  
  RESULTS
  There were no differences among groups in the demographic features, heart rate, mean arterial pressure, and peripheral oxygen saturation values. Group L had lower visual analogue scale value compared to the other postoperative groups (P < 0.01). In all groups, interleukin-6 (IL-6), IL-8, and IL-10 levels started to increase at 2 h and returned to the basal level at 24 h. IL levels increased in most of the epidural saline-administered group compared to other groups (P < 0.05).
  
  
  CONCLUSIONS
  Combined general anesthesia and TEA provided pain control and hemodynamic stability more efficiently during the first 24 h of the intraoperative and postoperative period by suppressing cytokine levels. However, we determined that this effect was more obvious with the local anesthetic and opioid combination.
authors.affiliation: Department of Anaesthesiology and Reanimation, Faculty of Medicine, Firat University, Elazig, Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Ozcan
authors.affiliation: Department of Anaesthesiology and Reanimation, Faculty of Medicine, Firat University, Elazig, Turkey.
authors.forename: A B
authors.initials: AB
authors.lastname: Ozer
authors.affiliation: Department of Anaesthesiology and Reanimation, Medical Park Goztepe Hospital, Istanbul, Turkey.
authors.forename: M A
authors.initials: MA
authors.lastname: Yasar
authors.affiliation: Department of Anaesthesiology and Reanimation, Faculty of Medicine, Firat University, Elazig, Turkey.
authors.forename: O L
authors.initials: OL
authors.lastname: Erhan
mesh_terms: D000767:Anesthesia, Epidural / Q000706:statistics & numerical data*; D000768:Anesthesia, General / Q000706:statistics & numerical data*; D017081:Cholecystectomy, Laparoscopic / Q000706:statistics & numerical data*; D016207:Cytokines / Q000097:blood*; D006801:Humans; D059408:Pain Management / Q000379:methods / Q000706:statistics & numerical data; D010149:Postoperative Pain / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control; D011446:Prospective Studies
chemical_list: D016207:Cytokines