Effects of epidural anesthesia and postoperative epidural analgesia on immune function in esophageal carcinoma patients undergoing thoracic surgery

Gu, Chengyong; Zhang, Jin; Qian, Yanning; Tang, Qi-Feng

doi:10.3892/mco.2014.405

Cited by 32 publications

(27 citation statements)

References 24 publications

(24 reference statements)

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“…As a result, the stress response is reduced and immune dysfunction is also minimized. 15 Therefore, it is possible that the previous study 7 used a small dose of IV opioid during surgery, although it was not specifically described. However, no epidural analgesia was used in this study due to possible complications associated with epidural catheterization.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Oncologic Outcomes for Patients Undergoing Volatile Versus Intravenous Anesthesia for Non-Small Cell Lung Cancer Surgery

Kim

Jheon

et al. 2018

Cancer Control

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Propofol-based total intravenous anesthesia (TIVA) has been reported to improve long-term outcome following cancer surgery, when compared with inhalation agents. However, such investigational reports are still controversial, and no studies have been conducted in relation to non-small cell lung cancer (NSCLC) surgery. The present study aimed to compare the favorable effects of TIVA versus inhalation agents on recurrence-free survival and overall survival after curative resection of NSCLC. This retrospective cohort study examined medical records of the patients who were diagnosed with NSCLC and underwent curative resection at Seoul National University Bundang Hospital from August 2003 to July 2012. The primary outcome included the comparison of postoperative overall survival and recurrence-free survival in both groups. To balance the 2 groups for analysis, a propensity matching method was used, and stratified Cox proportional hazard models were used for statistical analysis. This study included 943 cases of NSCLC for final analysis, and the cases were divided into the TIVA group (n = 749) and inhalation group (n = 194). Propensity matching produced 196 patients in each group. The final analysis revealed no significant difference in the hazard ratio (HR) for recurrence between the TIVA and inhalation groups (P = .233). The HR for death between the 2 groups was not significantly different either (P = .551). In this study, we found no benefit of propofol-based TIVA for long-term oncologic outcome after NSCLC surgery, relative to inhalation agents.

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Section: Discussionmentioning

confidence: 99%

Long-Term Oncologic Outcomes for Patients Undergoing Volatile Versus Intravenous Anesthesia for Non-Small Cell Lung Cancer Surgery

Kim

Jheon

et al. 2018

Cancer Control

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“…The present results agree with previous findings that patients receiving regional analgesia, including peripheral nerve blockade or epidural analgesia, experience lesser hyperalgesia than those receiving systemic multimodal analgesia [ 13 , 33 ]. In line with these results, techniques of regional analgesia, predominantly epidural postoperative analgesia, can significantly reduce altered inflammatory responses in the early postoperative period after major thoracic, abdominal, and orthopedics surgery [ 13 , 19 , 34 , 35 ]. By measuring blood glucose, insulin, and cortisol levels, as well as leukocyte count, as inflammatory markers, Bagry et al found that continuous lumbar plexus and sciatic peripheral nerve block effectively reduces pain after TKR and can attenuate distinct inflammatory responses [ 28 ].…”

Section: Discussionmentioning

confidence: 98%

“…Pain management after TKR is mandatory but usually difficult [ 1 ], and there are currently no unique postoperative pain management approaches. Despite the reported impacts of different methods of postoperative analgesia in patients undergoing major thoracic and abdominal surgery on cellular- and molecular-level alterations in the immune response, few studies exist on patients undergoing TKR [ 13 , 19 , 22 , 23 ]. Here, we report reductions in the frequency of circulating T lymphocytes, their subsets CD3 + CD4 + and CD3 + CD8 + cells, and NKT cells in patients receiving multimodal systemic analgesia compared to regional analgesia.…”

Section: Discussionmentioning

confidence: 99%

“…Different types of anesthesia and postoperative analgesia in patients undergoing surgery have been shown to maintain a better balance of cellular and humoral immunity [ 19 ]. Intravenous analgesia with opioids can attenuate postoperative pain, but there is strong evidence that it downregulates the immune response and leads to higher incidence of complication and prolonged recovery [ 20 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

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Postoperative Regional Analgesia Is Effective in Preserving Perforin-Expressing Lymphocytes in Patients After Total Knee Replacement

Brumnjak¹,

Rakovac²,

Kinkela³

et al. 2018

Med Sci Monit

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BackgroundPain and surgical stress cause a pro-inflammatory response followed by downregulation of the immune response, which can increase the incidence of postoperative complications, such as infections or prolonged wound healing. T lymphocytes and natural killer (NK) cells have cytotoxic potential and are crucial components of cellular immunity, which is important for maintenance of immune balance. The aim of this study was to analyze the effects of 3 types of postoperative analgesia on the preservation and cytotoxic potential of T lymphocytes, NK cells, and their subpopulations, as well as NKT cells, in patients after total knee replacement (TKR) to find the most effective analgesic technique for mitigating immune suppression.Material/MethodsForty-eight patients scheduled for TKR were randomly allocated to Group 1 (patients received epidural analgesia), Group 2 (patients received sciatic and femoral nerve block), or Group 3 (patients received multimodal systemic analgesia). Pain intensity was assessed at rest and on movement before, immediately after, and at 24 and 72 h after surgery. Blood samples were collected at the same time points and peripheral blood mononuclear cells were isolated. The frequencies of T lymphocytes, NK cells, and NKT cells, as well as their perforin expression, were simultaneously detected and analyzed by flow cytometry.ResultsPatients in Group 1 and Group 2 experienced less severe pain than those in Group 3. The frequencies and perforin levels of T lymphocytes, their subsets, and NKT cells were significantly lower in Group 3 than in Group 1 and Group 2.ConclusionsThe present study confirmed that regional analgesia is more effective in maintaining cell-mediated immunity and perforin expression in peripheral blood lymphocytes in patients after TKR.

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“…[ 4 ] At present, oxycodone is the only clinically used U-K dual receptor agonist. [ 5 , 6 ] An ideal drug should have a good postoperative analgesic effect and little influence on immune function. Few studies on the influence of oxycodone on immunity have been reported, at present.…”

Section: Introductionmentioning

confidence: 99%

Effects of oxycodone on immune function in patients undergoing radical resection of rectal cancer under general anesthesia

et al. 2017

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This study aims to explore the effect of oxycodone hydrochloride injection on the immune function of patients who underwent radical resection of rectal cancer under general anesthesia.Eighty patients were enrolled and randomly divided into group A and B (n = 40, each). All patients underwent general intravenous anesthesia. At the end of surgery, each patient in group A was injected with 5 mg (5 mL) of oxycodone hydrochloride, while 5 mg (5 mL) of morphine hydrochloride in group B. Venous blood was withdrawn in both groups at different time points. Changes in the numbers of T lymphocyte subsets and natural killer (NK) cells were determined by flow cytometry.First the numbers of T lymphocyte subsets and NK cells at T1, T2, T3, and T4 decreased in both groups, compared with those at T0, and the differences were statistically significant. Furthermore, the numbers reduced to a minimum at T2 and began to recover at T3. Second the differences between group A and B at T1, T2, T3, and T4 were statistically significant; and the numbers of T lymphocytes and NK cells were higher in group A than in group B at corresponding time points.Oxycodone hydrochloride and morphine hydrochloride both have inhibitory effects on immune function in patients undergoing radical resection of rectal cancer after surgery. However, oxycodone hydrochloride has a smaller effect compared to morphine hydrochloride.

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Effects of epidural anesthesia and postoperative epidural analgesia on immune function in esophageal carcinoma patients undergoing thoracic surgery

Cited by 32 publications

References 24 publications

Long-Term Oncologic Outcomes for Patients Undergoing Volatile Versus Intravenous Anesthesia for Non-Small Cell Lung Cancer Surgery

Long-Term Oncologic Outcomes for Patients Undergoing Volatile Versus Intravenous Anesthesia for Non-Small Cell Lung Cancer Surgery

Postoperative Regional Analgesia Is Effective in Preserving Perforin-Expressing Lymphocytes in Patients After Total Knee Replacement

Effects of oxycodone on immune function in patients undergoing radical resection of rectal cancer under general anesthesia

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