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Thoracic epidural analgesia inhibits the neuro-hormonal but not the acute inflammatory stress response following radical retropubic prostatectomy
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
Clinical Reaserch Centre, Örebro University, Sweden.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.ORCID iD: 0000-0001-5460-8888
Clinical Epidemiology and Biostatistical Unit, Örebro University Hospita.
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: Epidural anesthesia and analgesia has been shown to suppress the neurohormonalstress response in certain types of surgery, but its role in the inflammatory responseto surgery is unclear. The primary aim of this study was to assess whether the choice ofanalgesic technique influences these processes in patients undergoing radical retropubicprostatectomy (RRP).

Method: 26 patients undergoing RRP were randomized to Group P (systemic opioid-basedanalgesia) or Group E (thoracic epidural-based analgesia) perioperatively. Induction andmaintenance of anesthesia in both groups followed a standardized protocol. The followingmeasurements were made perioperatively : plasma cortisol, glucose, insulin, plasma cytokines(IL-6, TNF-a) and pokeweed mitogen-stimulated cytokines (IFN-g, IL-2, IL-12p70, IL-10,IL-4, and IL-17), C-reactive proteins and leucocyte count. Other parameters recordedincluded pain, morphine consumption and perioperative complications during 72 hours.

Results: Plasma concentration of cortisol and glucose were significantly higher in Group Pcompared to Group E at the end of surgery with a mean difference between groups of 232nmol/L (95% CI 84-381) (P=0.004) and 1.6 mmol/L (95% CI 0.6-2.5) (P=0.003) respectively.No significant differences were seen in any plasma cytokine except IL-17, which was higherin Group P compared with Group E, both at 24 h (P< 0.001) and 72 h (P=0.018)postoperatively. Significantly higher pain intensity was seen up to 24 hours postoperatively inGroup P compared to Group E (p < 0.05).

Conclusion: Thoracic epidural analgesia reduces the early postoperative stress response butnot the acute inflammatory response to radical retrobupic prostatectomy suggesting that otherpathways are involved during the acute phase reaction.

Keywords [en]
radical prostatectomy, stress response, inflammation, epidural, patient controlled, morphine, local anesthetics
National Category
Medical and Health Sciences
Research subject
Medicine; Surgery
Identifiers
URN: urn:nbn:se:oru:diva-22948OAI: oai:DiVA.org:oru-22948DiVA, id: diva2:528036
Available from: 2012-05-23 Created: 2012-05-23 Last updated: 2017-10-17Bibliographically approved
In thesis
1. Optimization of the perioperative anaesthetic care for prostate cancer surgery: clinical studies on pain, stress response and immunomodulation
Open this publication in new window or tab >>Optimization of the perioperative anaesthetic care for prostate cancer surgery: clinical studies on pain, stress response and immunomodulation
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Prostate cancer (PC) is the most common cancer form in men. Surgery is the treatment of choice for localized form of PC and half of all surgical procedures are radical retropubic prostatectomies (RRP). In the first two studies, we compared the efficacy of thoracic epidural analgesia to patientcontrolled analgesia (PCA) with intravenous morphine (I) and to patientcontrolled local analgesia by intra-abdominal injection of local anaesthetic(LA) (II) in treating postoperative pain after RRP. In studies III and IV we evaluated the effects of thoracic epidural analgesia compared to PCA with morphine in reducing the surgical stress reaction, inflammatory response (III) as well as the immune suppression (IV) following RRP. In studies I and II, we found better pain relief both at rest and on coughing, lower morphine consumption and better respiratory function postoperatively in patients having epidural analgesia. However, we did not register differences in time to home readiness or length of hospital stay. Painmanagement did not significantly affect health-related quality of life. In study III, early surgical stress response (plasma glucose and cortisol) was reduced two hours after the skin incision in patients having epidural analgesia compared with those having intravenous morphine analgesia but no differences in inflammatory mediators were seen except IL-17 which was lower in the epidural group. In study IV, no differences were found between epidural and PCA groups in leucocyte subpopulations, immunecell activation after mitogen stimulation or in natural killer cell cytotoxicityas a measure of innate immunity. We observed a low incidence of side effects and postoperative complications in all studies with no differences between the groups. In summary, thoracic epidural analgesia provided better postoperative pain relief, improved respiratory function and reduction in early stress response to radical retropubic prostatectomy, without any significant effects on inflammation or immune suppression.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2012. p. 97
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 69
Keywords
Radical retropubic prostatectomy, epidural analgesia, patientcontrolled local anaesthesia, patient-controlled analgesia, surgical stress response, local and general inflammatory reaction, immune response
National Category
Medical and Health Sciences Anesthesiology and Intensive Care Surgery
Research subject
Anaesthesiology; Surgery
Identifiers
urn:nbn:se:oru:diva-22804 (URN)978-91-7668-873-1 (ISBN)
Public defence
2012-06-07, Wilandersalen, M-huset, Universitetssjukhuset, Örebro, 09:00 (English)
Opponent
Supervisors
Available from: 2012-05-10 Created: 2012-05-10 Last updated: 2017-10-17Bibliographically approved

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Fant, FedericaHultgren-Hörnquist, ElisabethSandblom, DagAndersson, Swen-OlofAxelsson, KjellGupta, Anil

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