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BJA Advance Access originally published online on October 15, 2008
British Journal of Anaesthesia 2008 101(6):781-787; doi:10.1093/bja/aen287
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2008. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Intraoperative thoracic epidural anaesthesia attenuates stress-induced immunosuppression in patients undergoing major abdominal surgery{dagger}

O. Ahlers1,*, I. Nachtigall1, J. Lenze1, A. Goldmann1, E. Schulte1, C. Höhne2, G. Fritz3 and D. Keh1

1 Department of Anaesthesiology and Intensive Care Medicine, Charité—Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
2 Department of Anaesthesiology and Intensive Care Medicine, Universitaetsklinikum Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
3 Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Evangelisch-Freikirchliches Krankenhaus und Herzzentrum Brandenburg in Bernau, Ladeburger Str. 17, 16321 Bernau, Germany

* Corresponding author. E-mail: olaf.ahlers{at}charite.de

Background: Intraoperative stress may suppress the adaptive immune system. Abolished proinflammatory lymphocyte function is associated with higher risk of infection and postoperative complications. We hypothesized that thoracic epidural anaesthesia (TEA) reduces intraoperative stress and thus attenuates lymphocyte decrease and impairment of proinflammatory lymphocyte function.

Methods: Fifty-four patients undergoing major abdominal surgery who had a thoracic epidural catheter inserted were studied. In the TEA-I group, this catheter was used for intraoperative analgesia, whereas the TEA-P group received systemic opioids during surgery. In both groups, patient-controlled epidural analgesia was used for postoperative pain management. Blood samples for immune analyses were obtained before induction of anaesthesia, 2 h after skin incision, and at days 1 and 4 after surgery. Lymphocyte subpopulations, expression of human leucocyte antigen (HLA)-DR on monocytes, plasma concentrations of interleukin (IL)-10, interferon-{gamma} (IFN-{gamma}), and IL-12, and concanavalin-A-stimulated concentrations of IFN-{gamma} and IL-10 were measured. Intraoperative data including bispectral index and plasma concentrations of epinephrine/cortisol were analysed; APACHE-II, SAPS II, and additional postoperative data were documented.

Results: Plasma concentrations of epinephrine and cortisol were significantly lower in the TEA-I patients during surgery. IFN-{gamma}/IL-10 ratio was significantly higher in the TEA-I group from 2 h after skin incision until day 1. Lymphocyte numbers and T-helper cells were significantly higher in the TEA-I group at day 1, whereas no significant differences were detected among IL-12, HLA-DR, and postoperative clinical course.

Conclusions: Intraoperative use of thoracic epidural catheter reduced stress response and prevented stress-induced perioperative impairment of proinflammatory lymphocyte function.

Keywords: anaesthesia, general; anaesthetic techniques, epidural; blood, lymphocytes; immune response, suppression; polypeptides, cytokines, interleukins

{dagger} Declaration of interest. This study was supported by a grant from the B. Braun Stiftung (Melsungen, Germany).


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