Epidural anaesthesia and stress-induced immunosuppression
Birmingham, UK
E-mail: chavansl{at}doctors.org.uk
Editor—I was interested to read the study by Kawasaki and colleagues1 and would like to congratulate them on their excellent research work. However, reading through the article, I had a few questions unanswered. First, according to the authors, any further use of opioids apart from fentanyl at induction was avoided because of their immune-modulating effects. Does that mean that the patients in the general anaesthesia (GA) group did not require any other intraoperative analgesia for an upper abdominal procedure of more than 4 h? Secondly, in the Methodology, the authors mention starting epidural mepivacaine 1% at 5 ml h–1 along with fentanyl 20 µg h–1 in both groups, but the patients in the GA group did not have an epidural sited. Did the patients in the GA group have an epidural sited at the end of the procedure? Finally, there is no mention about postoperative pain relief in the patients in the GA group.
Even though the authors have worked extensively on the immunological markers, this study fails to provide basic anaesthetic care. I wonder whether this study will get ethical committee approval in the UK.
Kitakyushu, Japan
E-mail: mogata{at}med.uoeh-u.ac.jp
Editor—We would like to thank Dr Chavan for the important questions and interesting comments regarding our article. We also would like to apologize for our inadequate description of the method and dispel his misunderstandings.
First, we mainly maintained patient's haemodynamics by adjusting the concentration of the inhalation anaesthetics intraoperatively in the GA group. However, in a few patients who had persistent hypertension or tachycardia, we used pentazocine i.v.
Secondly, an epidural catheter was placed in the GA group patients (between T6 and T9) before induction, but epidural local anaesthetics or opioids were not used intraoperatively. After tracheal extubation, we immediately injected a bolus dose of epidural anaesthesia (5 ml mepivacaine 1%), followed by a continuous epidural infusion of mepivacaine 1% at 5 ml h–1 along with fentanyl 20 µg h–1 for 4 days.
On postoperative visiting, no patient in the GA group complained of unsatisfactory pain control with this method.
Reference
1 Kawasaki T, Ogata M, Kawasaki K, Okamoto K, Sata T. Effects of epidural anaesthesia on surgical stress-induced immunosuppression during upper abdominal surgery. Br J Anaesth (2007) 98:196–203.
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