Effects of anesthetic management on inflammatory markers in patients after major abdominal surgeries: A double blind controlled study

Faculty of Medicine

Assiut University

Effects of anesthetic management on inflammatory markers in patients after major abdominal surgeries: A double blind controlled study

Research Authors
Esam Hamed1, Nagla El-Melegy2, Samir Ammar3 and Rasha Hamed1*
Research Department
Department of  Anesthesia and Intensive Care
Research Journal
Journal of cellular and molecular anaesthesia
Research Member
Rasha Ahmed Ali Hamed
Research Abstract

BACKGROUND: Surgical trauma induces systemic inflammatory response due to hormonal, immunological, and metabolic mediators associated with augmented secretion of various stress hormones. Opioids and local anesthetics might suppress Hypothalamic-pituitary-adrenal (HPA) axis function, probably due to their analgesic effect, suppressing stress hormone production. We aimed to evaluate the influence of different analgesic models on postoperative pain and inflammatory markers modulation after major abdominal surgeries.

 

METHODS: A total of 105 patients scheduled for elective abdominal colorectal surgeries were selected. Patients received 15 mg Bupivacaine intrathecal (IT) followed by general anesthesia after stabilizing the block level at T-4. They received fluids infusion during the operation and for four hours after. They were randomly assigned to one of three study groups: Group-1 (GM): received four microgram/kg IT morphine, Group-2 (GML): received four microgram/kg IT morphine plus 1.5 mg/kg intravenous Lidocaine loading dose then 2 mg/min with the saline infusion during the operation and the next 4 hours postoperative and Group-3 (GC): (control group) received no added drugs

RESULTS: The mean pain score was significantly (P<0.001) lower in the GML group than the other groups. GML group showed the lowest level of tumor necrosis factor-alpha (P <0.001;) followed by GM and control groups (10.3 ± 4.4 vs. 20 ± 4.4 vs. 26 ± 7.5, respectively).  The level of Transforming Growth Factor beta 1 was significantly (P<0.001) higher in GML, followed by GM, and then GC (43.1 ± 12.5, 26 ± 4.2, and 18.9 ± 7.7, respectively).  Opioid consumption was significantly (P<0.001) lower in GML than the other two groups.

CONCLUSION: Intraoperative and early postoperative intravenous lidocaine infusion significantly improved the quality of postoperative analgesia. Optimizing analgesia in anesthetic management has a favorable effect on the pro and anti-inflammatory mediators.

 

Keywords: Abdominal surgeries, Postoperative pain, TNF-alpha and TGF-beta