Effect of thoracic epidural block on infection-induced inflammatory response: A randomized controlled trial.
Epidural block decreases inflammation and oxidative stress in experimental models of sepsis as well as after surgery. There is, however, no clinical evidence evaluating its effect on infection-induced inflammatory process. The present trial evaluated the effect of thoracic epidural block (TEB) on systemic inflammatory response in patients with small intestinal perforation peritonitis. Outcome measures included systemic levels of interleukin (IL)-6, IL-10, procalcitonin, and C-reactive protein and postoperative Sepsis-Related Organ Failure Assessment scores.



Sixty adult patients undergoing emergency abdominal laparotomy without any contraindication to TEB were randomized to receive general anesthesia alone or in combination with the TEB, which was continued for 48 hours postoperatively (n = 30 each).



Use of TEB was associated with a statistically insignificant trend of preservation of anti-inflammatory response depicted by higher levels of IL-10 and lack of alteration in proinflammatory IL-6, along with appreciably lower procalcitonin levels, decreased incidence of raised C-reactive protein levels, and better postoperative SOFA score (P > .05). It resulted in significantly better postoperative respiratory function and faster return of bowel motility (P < .05). Although the sample size is too small for conclusive statement, none of the patients developed epidural abscess.



Thoracic epidural block showed a trend toward better preservation of anti-inflammatory response and clinical recovery that, however, failed to achieve statistical significance (P > .05).
Department of Anaesthesiology & Critical Care, University College of Medical Sciences & GTB Hospital, Delhi 110095, India. Electronic address: drashatyagi@gmail.com.
Asha
A
Tyagi
Department of Anaesthesiology & Critical Care, University College of Medical Sciences & GTB Hospital, Delhi 110095, India. Electronic address: bansal.a.1988@gmail.com.
Anuradha
A
Bansal
Department of Microbiology, University College of Medical Sciences & GTB Hospital, Delhi 110095, India. Electronic address: shukladas_123@yahoo.com.
Shukla
S
Das
Department of Anaesthesiology & Critical Care, University College of Medical Sciences & GTB Hospital, Delhi 110095, India. Electronic address: newdraksethi@gmail.com.
Ashok Kumar
AK
Sethi
Department of Anaesthesiology & Critical Care, University College of Medical Sciences & GTB Hospital, Delhi 110095, India. Electronic address: kakkaraanchal2@gmail.com.
Aanchal
A
Kakkar
D000328:Adult; D000368:Aged; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D002097:C-Reactive Protein / Q000378:metabolism; D002116:Calcitonin / Q000097:blood; D003422:Critical Care; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D016753:Interleukin-10 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D018805:Sepsis / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D013904:Thoracic Vertebrae / Q000294:innervation*; D016896:Treatment Outcome; D055815:Young Adult
C508609:IL10 protein, human; C508600:IL6 protein, human; D015850:Interleukin-6; D016753:Interleukin-10; D002116:Calcitonin; D002097:C-Reactive Protein
Cytokines; Interleukin; Perforation peritonitis; Procalcitonin; Sepsis; Thoracic epidural block