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Thoracic epidural analgesia inhibits the neuro-hormonal but not the acute inflammatory stress response after radical retropubic prostatectomy
Department of Anesthesiology and Intensive Care, University Hospital, Örebro, Sweden.
Örebro University Hospital. Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Clinical Research Centre.
Department of Urology and the Health Academy, Örebro University Hospital, Örebro, Sweden.
Department of Urology and the Health Academy, Örebro University Hospital, Örebro, Sweden.
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2013 (English)In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 110, no 5, p. 747-757Article in journal (Refereed) Published
Abstract [en]

Background: Epidural anaesthesia and analgesia has been shown to suppress the neurohormonal stress response, but its role in the inflammatory response is unclear. The primary aim was to assess whether the choice of analgesic technique influences these processes in patients undergoing radical retropubic prostatectomy.

Methods: Twenty-six patients were randomized to Group P (systemic opioid-based analgesia) or Group E (thoracic epidural-based analgesia) perioperatively. Induction and maintenance of anaesthesia followed a standardized protocol. The following measurements were made perioperatively: plasma cortisol, glucose, insulin, C-reactive proteins, leucocyte count, plasma cytokines [interleukin (IL)-6, tumour necrosis factor (TNF)-alpha], and pokeweed mitogen-stimulated cytokines [interferon (IFN)-gamma, IL-2, IL-12p70, IL-10, IL-4, and IL-17]. Other parameters recorded were pain, morphine consumption, and perioperative complications.

Results: Plasma concentration of cortisol and glucose were significantly higher in Group P compared with Group E at the end of surgery, the mean difference was 232 nmol litre(-1) [95% confidence interval (CI) 84-381] (P=0.004) and 1.6 mmol litre(-1) (95% CI 0.6-2.5) (P=0.003), respectively. No significant differences were seen in IL-6 and TNF-alpha at 24 h (P=0.953 and 0.368, respectively) and at 72 h (P=0.931 and 0.691, respectively). IL-17 was higher in Group P compared with Group E, both at 24 h (P=0.001) and 72 h (P=0.018) after operation. Pain intensity was significantly greater in Group P compared with Group E (P<0.05) up to 24 h.

Conclusions: In this small prospective randomized study, thoracic epidural analgesia reduced the early postoperative stress response but not the acute inflammatory response after radical retrobupic prostatectomy, suggesting that other pathways are involved during the acute phase reaction.

Place, publisher, year, edition, pages
Oxford, USA: Oxford University Press, 2013. Vol. 110, no 5, p. 747-757
Keywords [en]
Anaesthesia technique, epidural, physiological, surgery: stress response, urological
National Category
Immunology in the medical area
Research subject
Biomedicine
Identifiers
URN: urn:nbn:se:oru:diva-29269DOI: 10.1093/bja/aes491ISI: 000318111900011PubMedID: 23295713Scopus ID: 2-s2.0-84876562596OAI: oai:DiVA.org:oru-29269DiVA, id: diva2:624353
Note

Funding Agencies:

Regional Research Committee 

Örebro County Council, Örebro, Sweden

Nyckelfond, Örebro Sweden 

Available from: 2013-05-31 Created: 2013-05-31 Last updated: 2018-05-18Bibliographically approved

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Tina, ElisabetAndersson, Swen-OlofHultgren-Hörnquist, ElisabethAxelsson, KjellGupta, Anil
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Örebro University HospitalSchool of Health and Medical Sciences, Örebro University, Sweden
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