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Combined general and epidural anaesthesia improves perioperative immune function

Background

Intraoperative stress may impair perioperative immune function. The hormones epinephrine, cortisol, and the stress-associated anti-inflammatory IL-10 are known to inhibit Th1 helper cells. Interferon-gamma (IFN-γ), released mainly by Th1 cells, seems to be crucial for host resistance; abolished Th1 function (anergy) is associated with increased risk of infection and mortality. We hypothesized that combined general and thoracic epidural anaesthesia (TEA) reduces intraoperative stress during major abdominal surgery preventing perioperative impairment of Th1 cells.

Methods

Fifty-four patients undergoing major abdominal surgery were enrolled in a controlled, prospective, randomized, and single-blinded study. The protocol was approved by the local ethics committee. All patients were supported with an epidural catheter before induction of general anaesthesia. In one group (n = 27), the catheter was used for intraoperative analgesia (TEA-I); the other group (n = 27) received systemic opioids during surgery (TEA-P). Subsequently, epidural analgesia was used in both groups for postoperative pain management. Blood samples were taken before placing the epidural catheter, 2 hours after the beginning of surgery, and at days 1 and 4 after surgery. IFN-γ and IL-10 were measured in plasma and concanavalin-A (ConA)-stimulated blood samples. Stress hormone levels of epinephrine and cortisol were examined. Differences between the groups were analysed using non-parametric tests, significance was defined by P < 0.05.

Results

The plasma IFN-γ/IL-10 ratio in TEA-P was lower 2 hours after the beginning of surgery (not significant). In ConA-stimulated lymphocytes, the IFN-γ/IL-10 ratio was significantly decreased in TEA-P from 2 hours after the beginning of surgery until day 1 (Fig. 1) (P = 0.005). This effect was mainly due to a significant decrease of IFN-γ in TEA-P, but not due to differences in IL-10 increase. Plasma levels of epinephrine (P = 0.022) and cortisol (P = 0.015) were significantly higher in TEA-P during surgery.

Figure 1
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(abstract P47)

Conclusion

The intraoperative use of a thoracic epidural catheter prevents stress-induced perioperative impairment of IFN-γ release. Since IFN-γ plays a key role in host defence, the results may be of clinical relevance for the postoperative course

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Ahlers, O., Kuerer, I., Lenze, J. et al. Combined general and epidural anaesthesia improves perioperative immune function. Crit Care 9, P146 (2005). https://doi.org/10.1186/cc3209

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Keywords

  • Cortisol
  • Epinephrine
  • Epidural Analgesia
  • Epidural Catheter
  • Major Abdominal Surgery