The effects of epidural anaesthesia and analgesia on T lymphocytes differentiation markers and cytokines in patients after gastric cancer resection

Abstract

Background: Epidural use can prevent peri-operative neuro-endocrine stress responses, mitigate pain after surgery, and reduce opioid use, which all lead to immunosuppression.

Methods: Forty patients with gastric cancer were ultimately enrolled into the study. Patients who received general anaesthesia (GA group, n = 20) or a combination of general anaesthesia and peri-operative epidural use (EGA group, n = 20) were given intravenous analgesia or epidural analgesia, respectively. We collected visual analogue scale (VAS) scores, length of hospital stay, the time of the first passage of flatus and incidence of postoperative nausea and vomiting (PONV). We also collected data on the cluster of differentiation markers (CD)³⁺, CD⁴⁺, CD⁸⁺, CD⁴⁺/CD⁸⁺, interleukin (IL)-4, IL-6, and interferon (IFN)-γ the day before surgery as well as on postoperative days 1, 3, and 7.

Results: VAS scores and PONV in the GA group were higher than in the EGA group on postoperative day 3. CD³⁺, CD⁴⁺, and CD⁴⁺/CD⁸⁺ T cells declined on postoperative day 3 and nearly recovered to baseline seven days after surgery in both groups. CD³⁺ T cells decreased more in the GA group than in the EGA group. IL-4, IL-6, and IFN-γ increased on postoperative day 3 and nearly recovered to baseline seven days after surgery in both groups. IL-4 and IL-6 increased more in the GA group than in the EGA group. IFN-γ increased more in the EGA group than in the GA group.

Conclusions: A combination of general anaesthesia and peri-operative epidural use can relieve postoperative pain and PONV. A combination of general anaesthesia and peri-operative epidural use decreases immunosuppression in gastric cancer resection.

Trial registration: The study procedures were approved by the Ethics Committee of The Harbin Medical University Cancer Hospital. This study was registered prospectively at http://www.chictr.org.cn/index.aspx on October 10, 2017 (Registered ChiCTR-INR-17012939 ).

Keywords: Cluster of differentiation; Cytokines; Epidural anaesthesia; General anaesthesia; Immune function; Patient-controlled analgesia.

Fig. 1

Patient identification and exclusion

Fig. 2

Comparison of IL-4 between the general anaesthesia group and epidural combined with general anaesthesia group on day (d) 0, the day before surgery, and on postoperative days 1, 3, and 7

Fig. 3

Comparison of IL-6 between the general anaesthesia group and epidural combined with general anaesthesia group on day (d) 0, the day before surgery, and on postoperative days 1, 3, and 7

Fig. 4

Comparison of IFN-γ between the general anaesthesia group and epidural combined with general anaesthesia group on day (d) 0, the day before surgery, and postoperative days 1, 3, and 7