The Effects of Epidural Block on the Distribution of Lymphocyte Subsets and Natural-Killer Cell Activity in Patients with and without Pain

Abstract

Although epidural anesthesia prevents immune suppression during surgery, no reports have elucidated how epidural block affects immune response in nonsurgical patients. We examined changes in proportion of lymphocyte subsets and in natural-killer (NK) cell activity in patients with and without pain. Fifteen patients with pain (Pain group) and 15 preoperative patients without pain (Preoperative group) received three different treatments in random order: epidural block with 7 mL 1% lidocaine, epidural injection of an identical volume of normal saline, and IV injection of 1 mg/kg lidocaine. Blood samples were drawn before and after 30, 60, and 120 min of treatment. During epidural block at 30 and 60 min, both groups showed significantly decreased epinephrine, norepinephrine, and cortisol levels, and the proportion of NK cells decreased, whereas the CD4+/CD8+ ratio increased significantly. NK cell activity in both groups decreased significantly at 30 and 60 min. At 120 min, the variables had all returned to preblock values. During treatments with saline and IV lidocaine, neither group showed significant changes in any of the above variables. We conclude that epidural block causes a transient and significant alteration of lymphocyte subsets and NK cell activity regardless of pain status.

Effect of spinal and general anesthesia on serum concentration of pro-inflammatory and anti-inflammatory cytokines

“…Other investigators have reported that epidural anesthesia had no effect on surgical stress in patients undergoing upper abdominal surgery (gastrectomy and partial hepatectomy) (Tonnensen et al 1984;Norman 1997;Kawasaki et al 2007). It is important to note that epidural anesthesia also induced significantly decreased epinephrine, norepinephrine and cortisol levels, the proportion of NK cells and alteration in the distribution of lymphocyte subsets in nonsurgical patients regardless of pain status (Yokoyama et al 2001). In contrast, patients undergoing abdominal surgery and receiving controlled epidural analgesia exhibited reduced suppression of lymphocyte mitogenic proliferation and attenuated proinflammatory cytokine response (IL-1␤, IL-2, IL-6) in postoperative period in comparison with patient-controlled analgesia and intermittent opiate regimen (Beilin et al 2003).…”

“…Pain is also a stressful event producing immunological alterations (Marbach et al 1990). Transient and minor effects of general and epidural anesthesia were observed on various immune parameters such as neutrophil phagocytic activity, neutrophil respiratory burst activity, mitogen-induced lymphocyte proliferative responses, NK-activity, proportions of T lymphocyte subsets, secretion and plasma levels of various proinflammatory and anti-inflammatory cytokines including IL-1␣, IL-6, TNF-␣, IL-10, IL-1Ra, IL-1␤, IL-2, IL-12, IFN-y and TGF-␤ (Sheeran and Hall 1997;Homburger and Meiler 2006;Schneemilch et al 2005;Helmy and Al-Attiyah 2001;Yokoyama et al 2001). Anesthetic management may have varying influences on postoperative immune response.…”

The effect of electroacupuncture on postoperative immunoinflammatory response in patients undergoing supratentorial craniotomy

“…Surgery and the resultant stress response lead to a suppression of immune function (5). The results of our study indicated that EA improves the immune function suppressed by surgery.…”

Anesthetics, immune cells, and immune responses

“…In addition to the management of intraoperative blood pressure, blood transfusion [8][9][10], hyperglycemia [11,12], hypothermia [13][14][15], and postoperative pain [16][17][18], which are managed by anesthesiologists during operations, cause perioperative immunosuppression (Fig. 2).…”