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Early perioperative immunological effects of anesthesia and analgesia in patients undergoing prostate cancer surgery
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, School of Health and Medical Sciences.
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background:Clinical studies in humans as well as experimental evidence from animal studiessuggests that the immune system plays an important role in perioperative metastases following cancer surgery. However, the precise role of the different components of the immune system in this process appears conflicting. Our primary aim was to assess T cell activity and natural killer (NK) cell toxicity in patients undergoing prostate cancer surgery and randomized to epidural or intravenous analgesia.

Methods:26 patients were randomized to receive general anaesthesia and patient controlled analgesia (PCA) with morphine postoperatively (Group P) or combined, general and epidural anaestesia with patient-controlled thoracic epidural analgesia postoperatively (Group E). Blood sample were obtained perioperatively at different time points for analyses of: subpopulations of leukocytes, cell- ediated immune response after mitogen stimulation, NK cell cytotoxicity, vascular endothelial growth factor (VEGF), IFN-g/IL-10 ratio, C-reactive protein (CRP) and white blood cell (WBC) count. In addition, pain and morphine consumtion were also determined.

Results: T lymphocytes decreased more in Group P compared to Group E at 24 hours postoperatively while T-helper lymphocytes decreased more in Group E compared to Group P at the same time point without reaching statistically significant difference.No differences were seen in NK cells or cytotoxic T lymphocytes between the groups. The CD4+/CD8+ ratio remained constant between the groups over time. Natural Killer Cell cytotoxicity did not show statistically significant differences between the groups at the different postoperative time points. No other differences ere found between the groups except in pain intensity which was lower in Group E, and morphine consumption which was greater in Group P. Conclusions:Our findings suggest that regional anaesthesia and analgesia appears to play a minor role in immunomodulation following surgery for prostate cancer. If regional anesthesia does prevent tumour growth or metastases perioperatively, the mechanism for this needs to be further elucidated.

Keywords [en]
patient controlled, thoracic epidural, radical prostatectomy, natural killer cells
National Category
Medical and Health Sciences
Research subject
Medicine; Surgery
Identifiers
URN: urn:nbn:se:oru:diva-22949OAI: oai:DiVA.org:oru-22949DiVA, id: diva2:528038
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
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Available from: 2012-05-10 Created: 2012-05-10 Last updated: 2017-10-17Bibliographically approved

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Fant, FedericaSandblom, DagAndersson, Swen-OlofHultgren-Hörnquist, ElisabethGupta, Anil

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