Postoperative Epidural Anesthesia Preserves Lymphocyte, but Not Monocyte, Immune Function After Major Spine Surgery

Volk, Thomas; Voigt, Kristina; Tohtz, Stephan; Putzier, Michael; Kox, Wolfgang J.

doi:10.1213/01.ane.0000104586.12700.3a

Cited by 76 publications

(48 citation statements)

References 22 publications

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“…Combined epidural/general anesthesia, as used in the present study, did not result in reduction of IL-6 concentration compared with general anesthesia alone. 32,33 In this study, IL-6 increased in all patients during surgery; however, peak concentrations were significantly lower in patients who received FA treatment. This may be a direct effect of FA, since both groups had a similar degree of tissue injury, with similar anesthetic and surgical management.…”

Section: Discussionmentioning

confidence: 44%

Intravenous flurbiprofen axetil accelerates restoration of bowel function after colorectal surgery

Tan

Chen

et al. 2008

Can J Anesth/J Can Anesth

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Purpose: Flurbiprofen axetil (FA) is a potent non-steroidal antiinflammatory drug (NSAID). We examined the effects that perioperative intravenous administration of FA, combined with thoracic epidural anesthesia and postoperative patient-controlled epidural analgesia (PCEA), have on bowel function, postoperative pain, and cytokine release, after open colorectal surgery. Methods:This was a prospective, randomized, double-blind, placebo-controlled study. Forty patients were randomly assigned to one of two groups (n = 20 in each group). The FA group patients received FA 1 mg·kg -1 iv, 30 min before and six hours after skin incision; whereas the control group patients received an equal volume of intralipid. Blood cytokine levels were measured before FA administration, at the end of surgery, and six hours and 24 hr postoperatively. All patients received postoperative PCEA for pain control. Analgesic efficacy was evaluated for 72 hr postoperatively using visual analogue scale (VAS) pain scores both at rest and during coughing. Gastrointestinal motility was recorded. Temperature and leukocyte count were measured preoperatively, and 24 hr postoperatively. Results:The times to first bowel movement (87 ± 23 vs 105 ± 19 hr, P = 0.008) and first flatus (63 ± 16 vs 75 ± 11 hr, P = 0.01) were earlier in the FA group compared to the control group. For the first 24 hr, the pain scores in the FA group were also lower during coughing (P < 0.001 compared to control). The plasma concentrations of interleukin (IL)-6 and IL-8 in the FA group were lower, postoperatively (P < 0.01 and P < 0.05, respectively, compared to control). In contrast, the IL-10 levels were significantly increased at six hours, postoperatively, in the FA group (P = 0.009). The total leukocyte count and the incidence of pyrexia were also lower in patients of the FA group (P = 0.001 and P = 0.006, respectively, compared to control). Conclusion:Flurbiprofen axetil may have an anti-inflammatory effect in major abdominal surgery. The combination of perioperative intravenous FA, intraoperative thoracic epidural anesthesia, and postoperative PCEA facilitated recovery of bowel function, enhanced analgesia, and attenuated the cytokine response.

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Section: Discussionmentioning

confidence: 44%

Intravenous flurbiprofen axetil accelerates restoration of bowel function after colorectal surgery

Tan

Chen

et al. 2008

Can J Anesth/J Can Anesth

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“…Neuraxial anesthesia may decrease the risk of a surgical site infection via transfusion, which has been shown to be a risk factor for surgical site infections [24]. However, the lower risk of systemic infections after using neuraxial anesthesia cannot be fully explained by reduction in transfusions and might be related to changes in immune system response after general and neuraxial anesthesia [5,25,26]. Volk et al [26] suggested that neuraxial anesthesia preserves lymphocyte functions, which may contribute to ''infectious resistance'' after neuraxial anesthesia.…”

Section: Discussionmentioning

confidence: 99%

“…However, the lower risk of systemic infections after using neuraxial anesthesia cannot be fully explained by reduction in transfusions and might be related to changes in immune system response after general and neuraxial anesthesia [5,25,26]. Volk et al [26] suggested that neuraxial anesthesia preserves lymphocyte functions, which may contribute to ''infectious resistance'' after neuraxial anesthesia. However, the exact mechanism of the protective effect of neuraxial anesthesia against systemic infections is unknown and additional study is required to elucidate the mechanism.…”

Section: Discussionmentioning

confidence: 99%

Is Neuraxial Anesthesia Safe in Patients Undergoing Surgery for Treatment of Periprosthetic Joint Infection?

Rasouli

Cavanaugh

Restrepo

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…Adaptive responses primarily use B and T cells, which are responsible for the specificity of the response. 3 Both comprise cellular and humoral components. 4 Serious injury upsets the immune system resulting in progressive suppression of the immune responses during the first week after surgical trauma, which is thought to contribute significantly to the development of sepsis and the multiorgan dysfunction syndrome.…”

Section: Introductionmentioning

confidence: 99%

Electroacupuncture Alleviates Intraoperative Immunosuppression in Patients Undergoing Supratentorial Craniotomy

et al. 2013

Acupunct Med

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Background Clinical experience suggests that anaesthesia using a combination of acupuncture and drugs can reduce the dosage of anaesthetics required for craniotomy, decreasing both the disturbance in physiological functions during the operation and postoperative complications and improving the rate of recovery. The aim of the present study was to investigate the impact of electroacupuncture (EA) on the dynamic equilibrium of the immune system and immune cell populations during the pericraniotomy period. Methods A total of 56 patients undergoing craniotomy were randomised into three groups: control (C, n=18), EA (A, n=19) and sham acupuncture (S, n=19) groups. Blood samples were collected before anaesthesia (T0) and 30 min, 2 h and 4 h after induction of anaesthesia (T1, T2 and T3, respectively,) to measure the levels of tumour necrosis factor α (TNFα), interleukin (IL)-8, IL-10, IgM, IgA, IgG and full blood count. Results There was no significant difference between the measurements in groups A and S during craniotomy. The levels of IgM and IgA decreased significantly in group C compared with groups A and S at T2 and T3 time points. The levels of total T cells and suppressor T cells in group C decreased significantly compared with groups A and S at T1 and T2, and the level of natural killer cells in group C decreased significantly compared with groups A and S at T1. No significant differences between groups were found in the levels of TNFα, IgG, IL-10, IL-8, leucocytes, neutrophils, monocytes, Th cells or B cells. Conclusions EA appears to reduce immunosuppression of both the humoral and cellular components during surgery.

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Postoperative Epidural Anesthesia Preserves Lymphocyte, but Not Monocyte, Immune Function After Major Spine Surgery

Cited by 76 publications

References 22 publications

Intravenous flurbiprofen axetil accelerates restoration of bowel function after colorectal surgery

Intravenous flurbiprofen axetil accelerates restoration of bowel function after colorectal surgery

Is Neuraxial Anesthesia Safe in Patients Undergoing Surgery for Treatment of Periprosthetic Joint Infection?

Electroacupuncture Alleviates Intraoperative Immunosuppression in Patients Undergoing Supratentorial Craniotomy

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