Selective Neurogenic Blockade and Perioperative Immune Reactivity in Patients Undergoing Lung Resection  

Oleh:

Viviano, E. ; Renius, M. ; Ruckert, J-C ; Bloch, A.

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: The Journal of International Medical Research vol. 40 no. 01 (Jan. 2012), page 141-156.
Topik: Remifentanil; Clonidine; Anaesthesia And Analgesia; Epidural Analgesia; Lung Resection; Postoperative Pain; Pneumonia; Immunomodulation

Ketersediaan

Perpustakaan FK Nomor Panggil: J11.K Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Isi artikel

OBJECTIVE: This double-blind, prospective, randomized, controlled trial examined the effects of thoracic epidural block and intravenous clonidine and opioid treatment on the postoperative Th1/Th2 cytokine ratio after lung surgery. The primary endpoint was the interferon ? (IFN-?; Th1 cytokine)/interleukin 4 (IL-4; Th2 cytokine) ratio. Secondary endpoints were reductions in pain and incidence of pneumonia. METHODS: Sixty patients were randomized into three groups to receive remifentanil intravenously (remifentanil group, n = 20), remifentanil and clonidine intravenously (clonidine group, n = 20), or ropivacaine epidurally (ropivacaine group, n = 20). Pain was assessed using a numerical rating scale (NRS). Cytokines were measured using a cytometric bead array. RESULTS: Patients in the ropivacaine group (thoracic epidural block) had a significantly lower IFN-?/IL-4 ratio at the end of surgery than those in the remifentanil group and clonidine group. There were no significant between-group differences in the IFN-?/IL-4 ratio at other time-points. There were no differences in NRS scores at any time-point. No patient developed pneumonia. CONCLUSION: Intraoperative thoracic epidural block decreased the IFN-?/IL-4 ratio immediately after lung surgery, indicating less inflammatory stimulation during surgery.

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