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Plasma concentration of epinephrine and cortisol at baseline and 40 min after skin incision; data are presented as box plots (median with quartiles); TEA-I, intraoperative and postoperative TEA; TEA-P, only postoperative TEA. *Significant differences between the treatment groups.
Source publication
Intraoperative stress may suppress the adaptive immune system. Abolished proinflammatory lymphocyte function is associated with higher risk of infection and postoperative complications. We hypothesized that thoracic epidural anaesthesia (TEA) reduces intraoperative stress and thus attenuates lymphocyte decrease and impairment of proinflammatory lym...
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Citations
... There has been a proposal for employing a combined protocol of regional/local anesthesia alongside general anesthesia in diverse clinical scenarios, with documented instances of heightened survival rates [39]. The augmented survival associated with combined anesthesia, as opposed to exclusive employment of general anesthesia, may be attributed to diminished inflammation and stress responses [41,42], along with reduced utilization of inhaled anesthetics [43,44] and opioids [43,45] during concurrent anesthesia administration. The inflammation and stress response [46] and the use of inhaled anesthetics [10,27] and opioids [47] have also been posited as potential contributors to the development of dementia. ...
... Accordingly, perioperative thoracic epidural anesthesia (TEA) remains a key component in the matter of improving clinically oriented outcomes [5,6]. This is not only because of its excellent analgesic properties [7], but also due to the reduction in the postoperative stress response, faster return of bowel function [8], and lower postoperative morbidity and mortality [9][10][11][12]. Nevertheless, the use of TEA is a matter of discussion for ORC as the benefit is debatable [13]. ...
The aim of this study was to evaluate the feasibility of opioid-free anesthesia (OFA) in open radical cystectomy (ORC) with urinary diversion and to assess the impact on recovery of gastrointestinal function. We hypothesized that OFA would lead to earlier recovery of bowel function. A total of 44 patients who underwent standardized ORC were divided into two groups (OFA group vs. control group). In both groups, patients received epidural analgesia (OFA group: bupivacaine 0.25%, control group: bupivacaine 0.1%, fentanyl 2 mcg/mL, and epinephrine 2 mcg/mL). The primary endpoint was time to first defecation. Secondary endpoints were incidence of postoperative ileus (POI) and incidence of postoperative nausea and vomiting (PONV). The median time to first defecation was 62.5 h [45.8–80.8] in the OFA group and 118.5 h [82.6–142.3] (p < 0.001) in the control group. With regard to POI (OFA group: 1/22 patients (4.5%); control group: 2/22 (9.1%)) and PONV (OFA group: 5/22 patients (22.7%); control group: 10/22 (45.5%)), trends but no significant results were found (p = 0.99 and p = 0.203, respectively). OFA appears to be feasible in ORC and to improve postoperative functional gastrointestinal recovery by halving the time to first defecation compared with standard fentanyl-based intraoperative anesthesia.
... Both types of anesthetics could not prevent postoperative syndecan-1 shedding, supporting the previous clinical studies showing comparable effects of these agents on endothelial glycocalyx damage in surgical patients [217]. A recent randomized control study demonstrated that sevoflurane could decrease glycocalyx degradation in patients undergoing heart valve surgery with CPB [218]. ...
Cardiac surgery is one of the highest-risk procedures, usually involving cardiopulmonary bypass and commonly inducing endothelial injury that contributes to the development of perioperative and postoperative organ dysfunction. Substantial scientific efforts are being made to unravel the complex interaction of biomolecules involved in endothelial dysfunction to find new therapeutic targets and biomarkers and to develop therapeutic strategies to protect and restore the endothelium. This review highlights the current state-of-the-art knowledge on the structure and function of the endothelial glycocalyx and mechanisms of endothelial glycocalyx shedding in cardiac surgery. Particular emphasis is placed on potential strategies to protect and restore the endothelial glycocalyx in cardiac surgery. In addition, we have summarized and elaborated the latest evidence on conventional and potential biomarkers of endothelial dysfunction to provide a comprehensive synthesis of crucial mechanisms of endothelial dysfunction in patients undergoing cardiac surgery, and to highlight their clinical implications.
... There remains a question of why epidural analgesia reduces the risk of postoperative complications and improve clinical outcomes. Some studies have demonstrated that epidural anesthesia/analgesia has bene cial effects on the surgical stress response [21] , return of gastrointestinal motility [20] , the incidence of postoperative pulmonary complications [22] , and postoperative morbidity and mortality [6] . Unfortunately, few studies have focused on the effects of PCEA in the elderly. ...
BACKGROUND
Patient-controlled intravenous analgesia (PCIA) and patient-controlled epidural analgesia (PCEA) constitute two major advances in pain management after major abdominal surgery. However, the effect of PCIA or PCEA has not been particularly studied in elderly patients with gastric cancer.
AIM
To compare the effect of PCIA to that of PCEA on short-term outcomes in elderly patients undergoing laparoscopic gastrectomy.
METHODS
This single-center, retrospective study included 254 elderly patients (≥ 70 years) who underwent laparoscopic radical gastrectomy for gastric cancer. Patients received either general anesthesia combined with epidural anesthesia followed by PCEA (PCEA group, n = 123) or general anesthesia alone followed by PCIA (PCIA group, n = 131). The primary endpoint was pain intensity tested using a 100-mm visual analog scale (VAS) on postoperative days 1, 2, and 3. Demographics, comorbidities, perioperative data, postoperative short-term outcomes, and analgesia-related side effects were also assessed.
RESULTS
The VAS scores at rest were lower in the PCEA group compared to the PCIA group on postoperative day 1, 2, and 3 (27.8 ± 13.9 vs 33.1 ± 15.0, P = 0.004; 25.2 ± 11.3 vs 30.1 ± 14.3, P = 0.002; 16.9 ± 7.1 vs 20.9 ± 9.5, P < 0.001; respectively). The postoperative hospital stay was shorter in the PCEA group than in the PCIV group (11 vs 12 days, P = 0.018). The times to postoperative first flatus, semifluid diet, full ambulation, and tracheal extubation after surgery in the PCEA group were significantly shorter than in the PCIA group. Overall morbidity, mortality, hospital readmission rate, and reoperation rate were not significantly different between the two groups. Regarding side-effects related to analgesia, there were no significant differences in terms of the rates of postoperative nausea and vomiting, urinary retention, or oxygen saturation < 90% between the two groups. However, PCEA was associated with a higher incidence of postoperative hypotension compared to PCIA (10.6% vs 3.8%, P = 0.036).
CONCLUSIONS
In elderly patients undergoing laparoscopic radical gastrectomy, epidural anesthesia and analgesia may convey superior pain relief, faster restoration of gastrointestinal motility, and shorter hospitalization.
... 1. Better analgesia leading to a less pronounced perioperative stress reaction [1] which preserves anticancer immunity (particularly natural killer cells' cytotoxicity). Such effects of epidural analgesia have been observed in open colectomy [3] and other major abdominal surgeries [4]. 2. Reduced exposition to volatile and intravenous anesthetics [1]. ...
Background Opioids and epidural analgesia are a mainstay of perioperative analgesia but their infuence on cancer
recurrence remains unclear. Based on retrospective data, we found that cancer recurrence following colorectal cancer
surgery correlates with the number of circulating tumor cells (CTCs) in the early postoperative period. Also, morphine�but not piritramide-based postoperative analgesia increases the presence of CTCs and shortens cancer-specifc
survival. The infuence of epidural analgesia on CTCs has not been studied yet.
Methods We intend to enroll 120 patients in four centers in this prospective randomized controlled trial. The study
protocol has been approved by Ethics Committees in all participating centers. Patients undergoing radical open
colorectal cancer surgery are randomized into epidural, morphine, and piritramide groups for perioperative analgesia.
The primary outcome is the diference in the number of CTCs in the peripheral blood before surgery, on the second
postoperative day, and 2–4 weeks after surgery. The number of CTCs is measured using molecular biology methods.
Perioperative care is standardized, and relevant data is recorded. A secondary outcome, if feasible, would be the
expression and activity of various receptor subtypes in cancer tissue. We intend to perform a 5-year follow-up with
regard to metastasis development.
... Previous studies have shown that the use of opioids decreased NK cell function in patients one day after surgery (39). The stability of IFN-g levels is closely related to the ordinary operation of NK cells (40). The results of our trial showed that Lido and Dex could preserve more NK cells, enhance IFN-g status, and increase IL-2 levels postoperatively, which was strongly associated with better survival of NSCLC patients (41). ...
Background
Neutrophil extracellular traps (NETs) can enhance the metastasis of non-small cell lung cancer (NSCLC). As biomarkers of tumor metastasis, metalloproteinases (MMPs) and vascular endothelial growth factor (VEGF) together with NETs are essential to endothelial-to-mesenchymal transition (EMT). We hypothesized that intravenous infusion of lidocaine and dexmedetomidine could reduce the production of NETs and biomarkers of tumor metastasis after video-assisted thoracic surgery (VATS) in NSCLC patients.
Method
The trial included 132 NSCLC patients undergoing VATS. The patients were equally randomized to a placebo group (Group C), a lidocaine group (Group L, intravenous lidocaine 8 mg/kg/h for 15 minutes before anesthesia, 2 mg/kg/h during surgery, and 1 mg/kg/h until 24 hours after surgery), a dexmedetomidine group (Group D, intravenous dexmedetomidine 2 μg/kg/h for 15 minutes before anesthesia, 0.5 μg/kg/h during surgery, and 0.25 μg/kg/h until 24 hours after surgery), and a dexmedetomidine plus lidocaine group (Group LD, combination use of lidocaine and dexmedetomidine). The primary outcome was the production of myeloperoxidase (MPO) and citrullinated histone-3 (H3Cit), biomarkers of NETs, on postoperative day (POD) 1. MMP-3, MMP-9, and VEGF-α, as biomarkers of tumor metastasis, were also evaluated on POD 1.
Results
The baseline patient characteristics and perioperative data did not differ between the study groups. MPO was significantly decreased in Groups L, D, and LD (-197.08 ± 34.01, -137.37 ± 32.41, and -189.45 ± 33.73 U/ml, P <0.001, respectively) compared with Group C (-106.51 ± 25.44 U/ml). H3Cit was also lessened in Groups L, D, and LD (-49.51 ± 9.11, -34.80 ± 10.37, and -51.82 ± 8.98 ng/ml, P <0.001, respectively) compared with Group C (-24.73 ± 7.65 ng/ml). Lidocaine and dexmedetomidine also reduced MMP-3 (-69.08 ± 13.22, -52.84 ± 13.78, -85.34 ± 12.59 vs. -40.55 ± 10.71 ng/ml in Group L, D, LD vs. Group C, P <0.001, respectively), MMP-9 (-8.46 ± 1.68, -6.07 ± 1.82, -9.67 ± 1.43 vs. -4.28 ± 1.29 ng/ml in Group L, D, LD vs. Group C, P<0.001, respectively), and VEGF-α (-95.55 ± 22.53, -71.65 ± 18.77, -104.89 ± 15.49 vs. -51.73 ± 16.27 pg/ml in Group L, D, LD vs. Group C, P<0.001, respectively) on POD 1.
Conclusion
In NSCLC patients, continuous perioperative intravenous infusion of lidocaine and dexmedetomidine significantly reduced the production of NETs and tumor metastasis biomarkers on POD 1. Meanwhile, it also decreased inflammation, protected cellular immune function, reduced pain and opioid consumption, and improved the quality of postoperative recovery.
Clinical trial registration
chictr.org.cn , identifier: 187049.
... The results showed that different anesthesia methods seem to have no significant effect on these cell functions. Another study reported that 54 patients requiring extensive abdominal surgery were treated with epidural anesthesia, which can prevent pressure-induced dysfunction of pro-inflammatory lymphocytes during the perioperative period (20). Our study found that the levels of IL-6, IL-8 and TNF-a in two groups showed an upward trend 24h-48h after surgery, and began to decline at 72h after surgery. ...
Objective: To investigate the effects of different anesthesia methods on the levels of inflammatory and coagulation factors in the peripheral blood of elderly patients undergoing hip surgery. Methods: 144 elderly patients undergoing hip arthroplasty in our hospital were randomly divided into ultrasound-guided lumbar-sciatic nerve block (group A) and epidural anesthesia (group B), 72 cases in each group. The postoperative hemodynamic indexes, pain score, inflammatory factors and coagulation factor levels were compared between the two groups. Results: (1) The postoperative VAS score of group B patients was lower than that of group A (P<0.05); (2) The SBP and DBP of group B were higher than those of group A at T1 and T2. (both P<0.05); (3) Compared with group A, the levels of IL-6, IL-8 and TNF-α in the peripheral blood of patients in group B decreased at postoperative T2, T3 and T4 (P<0.05); (4) Compared with group A, plasma FV:C, FVIII:C and FIB in group B decreased, and TT increased during surgery after T2, T3 and T4, (all P<0.05). Conclusion: Compared with epidural anesthesia, lumbar-sciatic nerve block can reduce the levels of peripheral blood coagulation factors and inflammatory factors after surgery.
... Compared with the control group, Syndecan-1 and heparin sulfate (HS) in maternal serum were significantly decreased, and α7nAChR expression in placental tissue was significantly up-regulated as well as the symptoms of proteinuria in puerpera were also relieved [15,16]. The protective effect of intraspinal labor analgesia may be related to spinal canal block to inhibit systemic inflammatory response and protect GCX from injury by enhancing vagal nerve activity and activating cholinergic anti-inflammatory pathway [17]. Based on the previous studies, we hypothesized that Ropivacaine via intraspinal administration might affect α7nAChR/glycocalyx to be conducive to kidney injury induced by preeclampsia. ...
Preeclampsia is characterized by hypertension and proteinuria, which is associated with kidney injury. Glycocalyx (GCX) degradation mediated endothelial injury can result in proteinuria and kidney damage. alpha 7 nicotinic acetylcholine receptor (α7nAChR) connects nervous and immune systems to respond to stress or injury. We aimed to explore the protective effect and mechanism of intraspinal analgesia on maternal kidney injury in preeclampsia. Endotoxin-induced preeclampsia rats treated with ropivacaine via intraspinal administration. Renal histopathological examination was performed, cell apoptosis in the kidney, the levels of Glycocalyx markers of Syndecan-1 and heparin sulfate (HS) in maternal serum, Syndecan-1 along with α7nAChR in the kidney were measured. Our results showed that kidney injury was obviously in preeclampsia rats with proteinuria, endothelial damage, higher apoptosis rate, increasing levels of Syndecan-1 and HS in serum, upregulated Syndecan-1 expression but downregulated α7nAChR expression in kidney. Preeclampsia rats treated with intraspinal injected ropivacaine attenuated preeclampsia-induced kidney injury as Syndecan-1 and HS were decreased in serum, Syndecan-1 expression was suppressed as well as α7nAChR was activated in the kidney. Our results suggested that Ropivacaine administered through the spinal canal may protect preeclampsia-induced renal injury by decreasing GCX and α7nAChR activation.
... When the hypothalamic-pituitary-adrenal axis is activated, T lymphocytes, NK cells, and macrophage activity can be suppressed. Sympathetic activation during surgery can induce decreased local perfusion and suppress immune cell activity due to effector cells binding with catecholamine [35]. Local anesthetics administered throughout the surgery can more directly affect cancer cells during regional anesthesia because antiproliferative effects of ropivacaine and lidocaine on tumor cells in vitro have been shown [36]. ...
Bladder cancers have high recurrence rates and are usually removed via transurethral resection of bladder tumor (TURBT). Recently, some reports showed that the anesthetic method may affect the recurrence rates of bladder cancers. The purpose of this population-based study was to compare the effect of anesthetic methods with the recurrence rates of bladder cancers in South Korea. A total of 4439 patients were reviewed retrospectively using the data of the Korean National Health Insurance (NHI) claims database from January 2007 to December 2011. Patients were divided into 2 groups who received general (n = 3767) and regional anesthesia (n = 582), and were followed up until September 2017. Propensity score matching was conducted to reduce the effect of confounding factors. After using propensity score matching with a multivariable Cox regression model, age (p < 0.001), sex (p < 0.001), hypertension (p = 0.003), diabetes mellitus (p = 0.001), and renal disease (p < 0.001) were significantly associated with bladder cancer recurrence. However, there were no significant differences in the recurrence rates of bladder cancers in patients who received general anesthesia and spinal anesthesia for TURBTs. This study revealed that there is no relationship between the anesthetic method and bladder cancer recurrence. Either general anesthesia or regional anesthesia can be used depending on the situation in patients receiving TURBT. Future prospective studies are warranted to confirm the association between the anesthetic method and the recurrence rates of bladder cancer.
... This may represent a risk for a patient in the perioperative setting. Therefore, one of the most important objectives for patient care is the reduction of perioperative stress (16,17). Lifestyle factors account for a small (at most 30%) percentage of cytotoxic activity that might become an additional biomarker to consider in a lifestyle intervention for cancer prevention. ...
Day surgery breast-conserving surgery (DS-BCS) is a surgical approach applied in many specialized breast surgery departments. This study demonstrates the benefits of this approach from the perspectives of patients and of the Hospital/National Health System compared to ordinary breast-conserving surgery (ORD-BCS) under general anesthetic. A comparison of costs and diagnosis-related group (DRG) reimbursement demonstrated improved cost-effectiveness in DS-BCS compared to ORD-BCS.
