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Intraoperative Epidural Analgesia Prevents the Early Proinflammatory Response to Surgical Trauma. Results from a Prospective Randomized Clinical Trial of Intraoperative Epidural Versus General Analgesia

  • Healthcare Policy and Outcomes
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Abstract

Background

The intraoperative epidural analgesia (EA) has the potential to reduce stress response to surgical trauma which induces a transient immunoactivation that has a negative impact on the outcome. This study investigates the effect of intraoperative EA versus intravenous analgesia (IA) on the immune function.

Methods

A total of 35 consecutive patients candidated to undergo major surgery for colon cancer were randomly assigned to intraoperative EA (n = 18) or IA (n = 17). Blood samples for TNF-α, IFN-γ, IL-1, IL-2, IL-4, IL-6, IL-10, IL-12, and GM-CSF were obtained before surgery (Tpre), 3 h (T3h), and 24 h (T24h) after skin incision. Data on postoperative complications were prospectively collected and analyzed.

Results

In the EA group, IL-4 increased from Tpre to T3h and from T3h to T24h, IL-10 increased from Tpre to T3h and persisted unmodified thereafter. At all time-points, IL-4 and IL-10 serum levels were significantly higher than those in the IA group. Conversely, in the IA group, IL-4 and IL-10 serum levels did not change while all other cytokines levels were significantly higher compared with the EA group. In particular, IL-6 progressively reached a 7-fold increase of its basal value at T24h. Complications were significantly more common in IA patients (13 of 17) compared with EA patients (7 of 18) (P = .024).

Conclusions

Our results indicate that in cancer patients undergoing major elective colon surgery, the EA attenuates the surgery-induced proinflammatory response and the typical postoperative transient immunosuppression and seems associated with a reduced rate of postoperative complications compared with IA.

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Acknowledgment

The authors wish to thank Ms. Sarah Capper for her editorial assistance during manuscript preparation.

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Authors and Affiliations

  1. Department of Anesthesiology, Intensive Care and Pain Therapy, IRCC—Institute for Cancer Research and Treatment, Candiolo, Italy

    Nora Maria Moselli MD, Elisa Baricocchi MD, Luisa Suita MD & Felicino Debernardi MD

  2. Division of Hepato-Biliary-Pancreatic and Digestive Surgery, Ospedale Mauriziano “Umberto I”, Torino, Italy

    Dario Ribero MD

  3. Analysis Laboratory, IRCC—Institute for Cancer Research and Treatment, Candiolo, Italy

    Antonio Sottile MD

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  1. Nora Maria Moselli MD
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  2. Elisa Baricocchi MD
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Correspondence to Dario Ribero MD.

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Moselli, N.M., Baricocchi, E., Ribero, D. et al. Intraoperative Epidural Analgesia Prevents the Early Proinflammatory Response to Surgical Trauma. Results from a Prospective Randomized Clinical Trial of Intraoperative Epidural Versus General Analgesia. Ann Surg Oncol 18, 2722–2731 (2011). https://doi.org/10.1245/s10434-011-1700-9

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