Background: Surgical stress is aggravated by anesthesia especially opioid-based
anesthesia. Epidural anesthesia (EA) was previously found to modulate the immune
response. Bupivacaine (BUP) may suffice as anesthetic but adjuvant might increase
this and possibly may modulate the stress response
Objectives: Evaluation of the effects of dexmedetomidine (DEX), fentanyl (FEN), or
tramadol (TRM) as adjuvants to BUP-EA on anesthetic outcomes and serum levels of
interleukin (IL)-6, IL-1β and Tumor necrosis factor-α (TNF-α) during varicose vein
surgery.
Patients and methods: 120 patients received single-shoot BUP 0.5% EA alone or
with 25, 50 and 100 µg of DEX, FEN and TRM, respectively. Blood samples were
obtained at start (T1) and end of surgery (T2) and 24-h postoperative (PO) (T3) for
ELISA estimations of cytokines' levels. Study outcomes include the effect of
adjuvants on anesthetic outcome and serum cytokines.
Results: Adjuvants significantly fastened complete sensory block especially
BUP/DEX and BUP/FEN with significant difference with BUP/DEX. Duration till
Bromage-3 was significantly shorter and duration till Bromage-2 and 0 grades were
significantly longer with DEX. Both DEX and FEN provided hemodynamic stability.
Adjuvants provided significantly better PO analgesia especially DEX. Serum
cytokines' levels were increased in all T2 and T3 samples than T1 levels, but levels
were the lowest with DEX. Serum TNF-α and IL-6 levels were negatively affected by
epidural adjuvants especially DEX.
Conclusion: EA ameliorates the surgery-induced inflammatory response and
adjuvants might augment this effect. Epidural BUP/DEX anesthesia significantly
suppressed, while BUP/FEN augments the serum cytokines' levels. |
