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Selective neurogenic blockade and perioperative immune reactivity in patients undergoing lung resection.
- Source :
-
The Journal of international medical research [J Int Med Res] 2012; Vol. 40 (1), pp. 141-56. - Publication Year :
- 2012
-
Abstract
- 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 γ (IFN-γ; Th1 cytokine)/interleukin 4 (IL-4; Th2 cytokine) ratio. Secondary endpoints were reductions in pain and incidence of pneumonia.<br />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.<br />Results: Patients in the ropivacaine group (thoracic epidural block) had a significantly lower IFN-γ/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-γ/IL-4 ratio at other time-points. There were no differences in NRS scores at any time-point. No patient developed pneumonia.<br />Conclusion: Intraoperative thoracic epidural block decreased the IFN-γ/IL-4 ratio immediately after lung surgery, indicating less inflammatory stimulation during surgery.
- Subjects :
- Aged
Amides administration & dosage
Amides pharmacology
Analgesics, Opioid administration & dosage
Analgesics, Opioid pharmacology
Anesthetics, Local administration & dosage
Anesthetics, Local pharmacology
Clonidine administration & dosage
Clonidine pharmacology
Female
Hemodynamics drug effects
Humans
Injections, Epidural
Injections, Intravenous
Interferon-gamma metabolism
Interleukin-4 metabolism
Lung physiopathology
Male
Middle Aged
Pain Measurement
Piperidines administration & dosage
Piperidines pharmacology
Remifentanil
Ropivacaine
Treatment Outcome
Lung immunology
Lung surgery
Nerve Block
Perioperative Care
Subjects
Details
- Language :
- English
- ISSN :
- 1473-2300
- Volume :
- 40
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- The Journal of international medical research
- Publication Type :
- Academic Journal
- Accession number :
- 22429354
- Full Text :
- https://doi.org/10.1177/147323001204000115