• Anesteziol Reanimatol · Nov 2014

    Randomized Controlled Trial

    [Effects of epidural anesthesia on stress-induced immune supression during major corrective spine surgery].

    • A A Ezhevskaia, Zh B Prusakova, L P Maksimova, M N Sholkina, E A Balmusova, and A M Ovechkin.
    • Anesteziol Reanimatol. 2014 Nov 1; 59 (6): 4-9.

    Study DesignA prospective, randomized study wias performed to compare two anesthetic methods.ObjectiveTo evaluate the effect of epidural analgesia on postoperative pain, endocrine- metabolic and inflammatory stress response and cellular inmmune responses during major corrective spine surgetry.MethodsThe study included 350 patients aged 15 to 65 who were randomly allocated to two equal groups. Group I (n=205) had continuous epidural analgesia (E4) and sevoflurane anesthesia during surgety and continuous epidural analgesia with ropivacaine and fentanil after surgery; Group 2 (n= 145) had general anesthesia with sevoflurane and fentanil and systemic administration of opioids after surgery. Patient pain, PONV syndrome, mobility, and satisfaction were measured after surgery along with plasma levels ofcortisol, ghmcose, interleukins IL-1β, IL-6, and IL-10 during and after surgemy C-reactive protein (CRP), and cell-surface receptor expression of immune cells (cluster of differentiation) HLA-DR+/CD3-, HLA-DR+/CD3+, HILA-DR, CD3, CD4, CD8, CD16, CD19 CD16/56+, and CD16/56+/CD3+) were measured perioperatively.ResultsIn group 1, there were significantly less pain, less nausea, earlier mobility, and higher satisfaction than those in group 2. Group I has also demonstrated significantly less plasma levels of glucose, cortisol, CRP, IL-lβ, IL-6, IL-10 at various stages. The ratio of CD4/CD8 (p=0.001) and B cells (p=0.01) have increased by postoperative day 3 in group 1. NK-cells (CD16/56+) have decreased significantly by day 3 after surgery (p=0.001) compared to the group 2. T-lymphocytes, (CD3) have decreased in all patients, but they were significantly lower in patients receiving opioids, compared wiith EA.ConclusionsPolerfulr afferent stimulation in major corrective spine surgery accompanied by immunosuppression for at least a wieek after surgery. EA reduces the surgical stress response, prevents postoperative lymphocyte apoptosis and thus, increases stress and infectious resistance.

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