Paravertebral block can attenuate cytokine response when it replaces general anesthesia for cancer breast surgeries

Abstract

Context: Cytokine release is a well-known response to surgery especially when it is linked to cancer. Paravertebral block (PVB) is the suitable regional anesthesia for breast surgery.

Aim: We tested the effect of replacing general anesthesia (GA) with PVB on cytokine response during and after surgeries for cancer breast.

Settings and design: Controlled randomized study.

Methods: Forty cancer breast patients were divided in two groups; Group I received PVB and Group II received GA during performance of unilateral breast surgery without axillary clearance. Plasma concentrations of interleukin (IL)-6, IL-10, IL-12 and interferon-γ (IFN-γ) were measured and IL-10/IFN-γ were estimated in the following points; before starting PVB in Group I or induction of GA in Group II (Sample A), before skin incision (Sample B), at the end of procedure before shifting out of operating room (Sample C), 4-h post-operatively (Sample D) and 24-h post-operatively (Sample E).

Statistical analysis: unpaired Student t-test.

Results: IL-6 increased progressively in both groups with statistically significant lower levels in samples C and D in Group I. IL-10 levels showed progressive increasing in both groups without differences between groups. IL-12 showed progressive decrease in both groups with statistically significant higher levels in samples C and D in Group I. IFN-levels showed significantly higher levels in samples C and D in Group I. IL-10/IFN-γ ratio was significantly lower in Group II in samples C and D.

Conclusion: Replacing GA with PVB can attenuate cytokines response to cancer breast surgeries.

Keywords: Cancer breast; interleukins; paravertebral block.