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Randomized Controlled Trial
. 2019 Dec;47(12):6160-6170.
doi: 10.1177/0300060519866943. Epub 2019 Aug 19.

Thoracic epidural anaesthesia and analgesia ameliorates surgery-induced stress response and postoperative pain in patients undergoing radical oesophagectomy

Jing Wang  1   2 , Yuehao Yin  1   2 , Yun Zhu  1   2 , Pingbo Xu  1   2 , Zhirong Sun  1   2 , Changhong Miao  1   2 , Jing Zhong  1   2
Affiliations
Randomized Controlled Trial

Thoracic epidural anaesthesia and analgesia ameliorates surgery-induced stress response and postoperative pain in patients undergoing radical oesophagectomy

Jing Wang et al. J Int Med Res. 2019 Dec.

Abstract

Objective: An acute severe stress response associated with major surgery can adversely affect the inflammatory and hormonal responses. We hypothesised that total intravenous anaesthesia (TIVA) combined with thoracic epidural anaesthesia and analgesia (TEA) attenuates the stress response and postoperative pain in patients undergoing radical oesophagectomy.

Methods: Forty patients scheduled for elective radical oesophagectomy were randomly assigned to one of two groups: TIVA or TIVA+TEA. The plasma levels of stress hormones and cytokines, consumption of fentanyl, postoperative visual analogue scale (VAS) scores within 48 hours, and extubation time were assessed.

Results: The plasma levels of interleukin-6, norepinephrine, cortisol, and adrenocorticotropic hormone at 3 hours after the beginning of surgery were significantly higher in the TIVA group than TIVA+TEA group. The plasma level of interleukin-10 at 3 hours after the beginning of surgery was significantly lower in the TIVA group than TIVA+TEA group. The consumption of fentanyl was significantly greater, VAS scores were significantly higher, and extubation time was significantly longer in the TIVA group than TIVA+TEA group.

Conclusions: The findings suggest that combination of TIVA and TEA may attenuate the intraoperative stress response and postoperative pain in patients undergoing radical oesophagectomy.

Keywords: Epidural; anaesthesia; analgesia; immunity; oesophagectomy; stress.

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Figures

Figure 1.
Figure 1.
CONSORT diagram illustrating the patient flow in the present study. TEA, thoracic epidural anaesthesia and analgesia; TIVA, total intravenous general anaesthesia.
Figure 2.
Figure 2.
Comparison of the RE, SE, and MAP levels. Comparison of (a) RE, (b) SE, and (c) MAP levels before and during the surgery between the TIVA+TEA group and TIVA group. RE, response entropy; SE, state entropy; MAP, mean arterial pressure; TIVA, total intravenous general anaesthesia; TEA, thoracic epidural anaesthesia and analgesia.
Figure 3.
Figure 3.
Comparison of ACTH, CORT, IL-6, NE, and IL-10 levels. Plasma (a) ACTH, (b) CORT, (c) IL-6, (d) NE, and (e) IL-10 levels before surgery, 1 hour after the beginning of surgery, and 3 hours after the beginning of surgery were measured between the TIVA+TEA group and TIVA group using enzyme-linked immunosorbent assay. *p < 0.05 was considered to be statistically significant versus TIVA. ACTH, adrenocorticotropic hormone; CORT, cortisone; IL, interleukin; NE, norepinephrine; TIVA, total intravenous general anaesthesia; TEA, thoracic epidural anaesthesia and analgesia.
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