Oxidative Stress and Inflammation Biomarkers in Postoperative Pain Modulation in Surgically Treated Patients with Laryngeal Cancer-Pilot Study

Katarina Savic Vujovic, Andjela Zivkovic, Ivan Dozic, Andja Cirkovic, Branislava Medic, Dragana Srebro, Sonja Vuckovic, Jovica Milovanovic, Ana Jotic, Katarina Savic Vujovic, Andjela Zivkovic, Ivan Dozic, Andja Cirkovic, Branislava Medic, Dragana Srebro, Sonja Vuckovic, Jovica Milovanovic, Ana Jotic

Abstract

(1) Background: Surgical treatment of laryngeal carcinoma includes different types of laryngectomies with neck dissection. Surgical tissue damage triggers an inflammatory response, leading to the release of pro-inflammatory molecules. This increases reactive oxygen species production and decreases antioxidant defense mechanisms, leading to postoperative oxidative stress. The aim of this study was to assess the correlation between oxidative stress (malondialdehyde, MDA; glutathione peroxidase, GPX; superoxide dismutase, SOD) and inflammation (interleukin 1, IL-1; interleukin-6, IL-6; C-reactive protein, CRP) parameters and postoperative pain management in patients surgically treated with laryngeal cancer. (2) Methods: This prospective study included 28 patients with surgically treated laryngeal cancer. Blood samples were taken for the analysis of oxidative stress and inflammation parameters before the operative treatment and after the operative treatment (1st postoperative day and 7th postoperative day). The concentrations of MDA, SOD, GPX, IL-1, IL-6, and CRP in the serum were determined by coated enzyme-linked immunosorbent assay (ELISA). The visual analog scale (VAS) was used for pain assessment. (3) Results and conclusion: There was a correlation between oxidative stress and inflammation biomarkers and postoperative pain modulation in surgically treated patients with laryngeal cancer. Age, more extensive surgery, CRP values, and use of tramadol were predictors for oxidative stress parameters.

Keywords: MDA; NSAID; SOD; oxidative stress; postoperative pain; tramadol.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Visual analog scale (VAS) scores of the patients through the evaluated period of time (preoperative, 1st postoperative, and 7th postoperative day). There was a statistically significant difference between pain intensity preoperative and on the 1st postoperative day, as well as from the 1st to the 7th postoperative day (p < 0.001).
Figure 2
Figure 2
Analgesics prescribed in pain therapy. Ketorolac or metamizole were used as NSAIDs. Tramadol was used as the only opioid analgesic. Multimodal analgesia involved the use of NSAIDs and an opioid or NSAIDs and acetaminophen.
Figure 3
Figure 3
Values of oxidative stress parameters through the evaluated period of time. There was a significant change in values of SOD as a parameter of anti-oxidative stress and MDA as a parameter of oxidative stress from preoperative to the 7th postoperative day (p < 0.001). (MDA—malondialdehyde; SOD—superoxide dismutase).
Figure 4
Figure 4
Significant correlations between oxidative stress and inflammation parameters preoperatively. Negative moderate correlation between IL-1 and GPX and between IL-6 and CRP and positive moderate correlation between IL-1 and SOD were obtained for the level of significance of GPX—glutathione peroxidase, SOD—superoxide dismutase, IL-1—interleukin 1, IL-6—interleukin-6, CRP—C-reactive protein).
Figure 5
Figure 5
Significant correlations between oxidative stress and inflammation parameters on the 1st postoperative day. Positive moderate correlation between MDA and CRP and SOD and CRP were shown for the level of significance of MDA—malondialdehyde, SOD—superoxide dismutase, CRP—C-reactive protein).
Figure 6
Figure 6
Significant correlations between oxidative stress and inflammation parameters on the 7th postoperative day. Negative moderate correlation between SOD and CRP and positive moderate correlation between GPX and MDA and GPX and IL-6 were shown for the level of significance of MDA—malondialdehyde, GPX—glutathione peroxidase, SOD—superoxide dismutase, CRP—C-reactive protein).

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