The Effects of Postoperative Pain Management on Immune Response to Surgery

Abstract

Surgery is associated with immune alterations, which are the combined result of tissue damage, anesthesia, postoperative pain, and psychological stress. In the present study, we compared the effects of several postoperative pain management techniques on postoperative immune function. Patients hospitalized for abdominal surgery were randomly assigned to one of three postoperative pain management techniques: opiates on demand (intermittent opiate regimen [IOR]), patient-controlled analgesia (PCA), and patient-controlled epidural analgesia (PCEA). Postoperative pain was assessed. Blood samples were collected before and 24, 48, and 72 h after surgery. Production of interleukin (IL)-1beta, IL-2, and IL-6, natural killer cell cytotoxicity, and lymphocyte mitogenic responses were assessed. Patients of the PCEA group exhibited lower pain scores in the first 24 h after surgery compared with patients of the IOR and PCA groups. Mitogenic responses were suppressed in all groups in the first 24 h, returned to preoperative values by 72 h in the PCEA group, but remained suppressed in the PCA group. Production of IL-1beta and IL-6 increased in the IOR and PCA groups, whereas it remained almost unchanged in the PCEA group. Patients receiving an epidural mixture of opiate and local anesthetics (PCEA group) exhibited reduced suppression of lymphocyte proliferation and attenuated proinflammatory cytokine response in the postoperative period.

Impact of Awake Videothoracoscopic Surgery on Postoperative Lymphocyte Responses

“…Papadima and colleagues [26] have found that epidural anesthesia did not suppress postoperative lymphocyte apoptosis in patients receiving major abdominal surgery. Beilin and colleagues [27] showed that epidural analgesia may protect against late (Ͻ72 hours) postoperative lymphocyte suppression, but this effect was not found when restricting the analysis to the early postoperative period. Furthermore, Yokoyama and colleagues [6] found that epidural anesthesia is associated with a transient reduction in natural-killer activity that has been considered unrelated to the pain Avoidance of OLV could also have contributed to the more physiologic lymphocyte response observed in awake patients.…”

Effects of Surgical Stress on Early Nonspecific Immune Response in Children

“…There are however reports contradictory to this, suggesting at least some parts of the immune response may be unchanged [4,5] or enhanced [6]. The various cellular components, namely neutrophils, monocytes, and lymphocytes, have been studied [1,[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. The phagocytic activity of neutrophils has been found to be reduced [3] or unchanged [4], while the serum opsonic activity is found to be decreased after surgery.…”

Surgical Trauma and Immune Functional Changes Following Major Lung Resection

“…Apart from surgical access trauma per se, other factors favoring VATS lung resection, such as reduced postoperative pain, may also have an important contribution in preserving postoperative cellular immunity by reducing lymphocyte suppression and attenuate proinflammatory cytokine responses [50]. Furthermore, VATS major lung resection encompasses a spectrum of techniques and is not a unified approach [11]; therefore, variations in the use of and size of utility thoracotomy, the number of incisions and port sites used [1], the practice of rib spreading and segmental rib resection [51], as well as the duration of surgery may all have addition effects on postoperative inflammatory and immune responses.…”