• Anesthesia and analgesia · Nov 2005

    Randomized Controlled Trial Clinical Trial

    The effects of continuous epidural anesthesia and analgesia on stress response and immune function in patients undergoing radical esophagectomy.

    • Masataka Yokoyama, Yoshitaro Itano, Hiroshi Katayama, Hiroshi Morimatsu, Yoshimasa Takeda, Toru Takahashi, Osamu Nagano, and Kiyoshi Morita.
    • Department of Anesthesiology and Resuscitology, Okayama University Medical School, 2-5-1, Shikata-cho, Okayama City, Okayama 700-8558, Japan. masayoko@cc.okayama-u.ac.jp
    • Anesth. Analg. 2005 Nov 1;101(5):1521-7.

    AbstractWe investigated whether perioperative extensive epidural block (C3-L) affects postoperative immune response in patients undergoing radical esophagectomy. Patients undergoing radical esophagectomy were randomly assigned to either general anesthesia with continuous epidural infusion via 2 epidural catheters that was continued for postoperative analgesia (group E, n = 15) or intraoperative general anesthesia and postoperative IV morphine analgesia (group G, n = 15). Plasma levels of stress hormones, cytokines, C-reactive protein (CRP), leukocyte counts, and distribution of lymphocyte subsets were assessed before and after surgery and on postoperative days (PODs) 1 and 3. In comparison with group E, significant increases in plasma epinephrine level at the end of surgery (P < 0.05) and norepinephrine level at the end of surgery (P < 0.01) and on POD1 (P < 0.01) and POD3 (P < 0.01) and significant decrease in cluster of differentiation (CD4/CD8 ratio) at the end of surgery (P < 0.05) were observed in group G. However, there were no significant differences in other variables between groups. In both groups, plasma cortisol, adrenocorticotropic hormone, interleukin (IL)-1beta, IL-6, IL-10, and CRP levels were increased after surgery (each group P < 0.01) and IL-1beta, IL-6, IL-10, and CRP were still increased on POD1 and POD3 (each change, each group P < 0.01). Leukocyte counts were increased on POD1 (each group P < 0.05) and POD3 (each group P < 0.01). The proportion of lymphocytes decreased from the end of surgery to POD3 (each group P < 0.01). The proportion of B cells was increased on POD1 (each group P < 0.01); that of natural killer cells was decreased at POD1 and POD3 (each group P < 0.01). We conclude that tissue damage and inflammation apparently overcome the effects of extensive epidural block on stress response and immune function in radical esophagectomy.

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