Paravertebral block can attenuate cytokine response when it replaces general anesthesia for cancer breast surgeries

Sherif S Sultan, Sherif S Sultan

Abstract

Context: Cytokine release is a well-known response to surgery especially when it is linked to cancer. Paravertebral block (PVB) is the suitable regional anesthesia for breast surgery.

Aim: We tested the effect of replacing general anesthesia (GA) with PVB on cytokine response during and after surgeries for cancer breast.

Settings and design: Controlled randomized study.

Methods: Forty cancer breast patients were divided in two groups; Group I received PVB and Group II received GA during performance of unilateral breast surgery without axillary clearance. Plasma concentrations of interleukin (IL)-6, IL-10, IL-12 and interferon-γ (IFN-γ) were measured and IL-10/IFN-γ were estimated in the following points; before starting PVB in Group I or induction of GA in Group II (Sample A), before skin incision (Sample B), at the end of procedure before shifting out of operating room (Sample C), 4-h post-operatively (Sample D) and 24-h post-operatively (Sample E).

Statistical analysis: unpaired Student t-test.

Results: IL-6 increased progressively in both groups with statistically significant lower levels in samples C and D in Group I. IL-10 levels showed progressive increasing in both groups without differences between groups. IL-12 showed progressive decrease in both groups with statistically significant higher levels in samples C and D in Group I. IFN-levels showed significantly higher levels in samples C and D in Group I. IL-10/IFN-γ ratio was significantly lower in Group II in samples C and D.

Conclusion: Replacing GA with PVB can attenuate cytokines response to cancer breast surgeries.

Keywords: Cancer breast; interleukins; paravertebral block.

Conflict of interest statement

Conflict of Interest: None declared.

References

    1. Jemal A, Center MM, DeSantis C, Ward EM. Global patterns of cancer incidence and mortality rates and trends. Cancer Epidemiol Biomarkers Prev. 2010;19:1893–907.
    1. Buggy DJ, Smith G. Epidural anaesthesia and analgesia: Better outcome after major surgery? Growing evidence suggests so. BMJ. 1999;319:530–1.
    1. Exadaktylos AK, Buggy DJ, Moriarty DC, Mascha E, Sessler DI. Can anesthetic technique for primary breast cancer surgery affect recurrence or metastasis? Anesthesiology. 2006;105:660–4.
    1. Dabbagh A, Elyasi H. The role of paravertebral block in decreasing postoperative pain in elective breast surgeries. Med Sci Monit. 2007;13:CR464–7.
    1. Schnabel A, Reichl SU, Kranke P, Pogatzki-Zahn EM, Zahn PK. Efficacy and safety of paravertebral blocks in breast surgery: A meta-analysis of randomized controlled trials. Br J Anaesth. 2010;105:842–52.
    1. Das S, Bhattacharya P, Mandal MC, Mukhopadhyay S, Basu SR, Mandol BK. Multiple-injection thoracic paravertebral block as an alternative to general anaesthesia for elective breast surgeries: A randomised controlled trial. Indian J Anaesth. 2012;56:27–33.
    1. Ibarra MM, S-Carralero GC, Vicente GU, Cuartero del Pozo A, López Rincón R, Fajardo del Castillo MJ. Chronic postoperative pain after general anesthesia with or without a single-dose preincisional paravertebral nerve block in radical breast cancer surgery. Rev Esp Anestesiol Reanim. 2011;58:290–4.
    1. Toews GB. Cytokines and the lung. Eur Respir J Suppl. 2001;34:3s–17.
    1. Karmakar MK. Thoracic paravertebral block. Anesthesiology. 2001;95:771–80.
    1. O’Riain SC, Buggy DJ, Kerin MJ, Watson RW, Moriarty DC. Inhibition of the stress response to breast cancer surgery by regional anesthesia and analgesia does not affect vascular endothelial growth factor and prostaglandin E2. Anesth Analg. 2005;100:244–9.
    1. Deegan CA, Murray D, Doran P, Moriarty DC, Sessler DI, Mascha E, et al. Anesthetic technique and the cytokine and matrix metalloproteinase response to primary breast cancer surgery. Reg Anesth Pain Med. 2010;35:490–5.
    1. Helmy SA, Wahby MA, El-Nawaway M. The effect of anaesthesia and surgery on plasma cytokine production. Anaesthesia. 1999;54:733–8.
    1. Sheeran P, Hall GM. Cytokines in anaesthesia. Br J Anaesth. 1997;78:201–19.
    1. Schulze-Tanzil G, Al-Sadi O, Wiegand E, Ertel W, Busch C, Kohl B, et al. The role of pro-inflammatory and immunoregulatory cytokines in tendon healing and rupture: New insights. Scand J Med Sci Sports. 2011;21:337–51.
    1. Silveira FP, Nicoluzzi JE, Saucedo NS, Júnior, Silveira F, Nicollelli GM, Maranhão BS. Evaluation of serum levels of interleukin-6 and interleukin-10 in patients undergoing laparoscopic versus conventional cholecystectomy. Rev Col Bras Cir. 2012;39:33–40.
    1. Ertel W, Faist E, Nestle C, Hueltner L, Storck M, Schildberg FW. Kinetics of interleukin-2 and interleukin-6 synthesis following major mechanical trauma. J Surg Res. 1990;48:622–8.
    1. Hirano T, Taga T, Matsuda T, Hibi M, Suematsu S, Tang B, et al. Interleukin 6 and its receptor in the immune response and hematopoiesis. Int J Cell Cloning. 1990;8(Suppl 1):155–66.
    1. D’Andrea A, Aste-Amezaga M, Valiante NM, Ma X, Kubin M, Trinchieri G. Interleukin 10 (IL-10) inhibits human lymphocyte interferon gamma-production by suppressing natural killer cell stimulatory factor/IL-12 synthesis in accessory cells. J Exp Med. 1993;178:1041–8.
    1. Bielawska-Pohl A, Blesson S, Benlalam H, Trenado A, Opolon P, Bawa O, et al. The anti-angiogenic activity of IL-12 is increased in iNOS-/- mice and involves NK cells. J Mol Med (Berl) 2010;88:775–84.
    1. Pietras EM, Saha SK, Cheng G. The interferon response to bacterial and viral infections. J Endotoxin Res. 2006;12:246–50.
    1. Faist E, Ertel W, Cohnert T, Huber P, Inthorn D, Heberer G. Immunoprotective effects of cyclooxygenase inhibition in patients with major surgical trauma. J Trauma. 1990;30:8–17.
    1. Kehlet H. The surgical stress response: Should it be prevented? Can J Surg. 1991;34:565–7.
    1. Lyons FM, Bew S, Sheeran P, Hall GM. Effects of clonidine on the pituitary hormonal response to pelvic surgery. Br J Anaesth. 1997;78:134–7.
    1. Naito Y, Tamai S, Shingu K, Shindo K, Matsui T, Segawa H, et al. Responses of plasma adrenocorticotropic hormone, cortisol, and cytokines during and after upper abdominal surgery. Anesthesiology. 1992;77:426–31.
    1. Kim MH, Hahm TS. Plasma levels of interleukin-6 and interleukin-10 are affected by ketorolac as an adjunct to patient-controlled morphine after abdominal hysterectomy. Clin J Pain. 2001;17:72–7.
    1. Kuo CP, Jao SW, Chen KM, Wong CS, Yeh CC, Sheen MJ, et al. Comparison of the effects of thoracic epidural analgesia and i.v. infusion with lidocaine on cytokine response, postoperative pain and bowel function in patients undergoing colonic surgery. Br J Anaesth. 2006;97:640–6.
    1. Volk T, Schenk M, Voigt K, Tohtz S, Putzier M, Kox WJ. Postoperative epidural anesthesia preserves lymphocyte, but not monocyte, immune function after major spine surgery. Anesth Analg. 2004;98:1086–92.
    1. Beilin B, Shavit Y, Trabekin E, Mordashev B, Mayburd E, Zeidel A, et al. The effects of postoperative pain management on immune response to surgery. Anesth Analg. 2003;97:822–7.
    1. Yokoyama M, Itano Y, Katayama H, Morimatsu H, Takeda Y, Takahashi T, et al. The effects of continuous epidural anesthesia and analgesia on stress response and immune function in patients undergoing radical esophagectomy. Anesth Analg. 2005;101:1521–7.
    1. Hong JY, Lim KT. Effect of preemptive epidural analgesia on cytokine response and postoperative pain in laparoscopic radical hysterectomy for cervical cancer. Reg Anesth Pain Med. 2008;33:44–51.
    1. Kawasaki T, Ogata M, Kawasaki C, Okamoto K, Sata T. Effects of epidural anaesthesia on surgical stress-induced immunosuppression during upper abdominal surgery. Br J Anaesth. 2007;98:196–203.
    1. Ahlers O, Nachtigall I, Lenze J, Goldmann A, Schulte E, Höhne C, et al. Intraoperative thoracic epidural anaesthesia attenuates stress-induced immunosuppression in patients undergoing major abdominal surgery. Br J Anaesth. 2008;101:781–7.
    1. Ahlers O, Hildebrandt B, Dieing A, Deja M, Böhnke T, Wust P, et al. Stress induced changes in lymphocyte subpopulations and associated cytokines during whole body hyperthermia of 41.8-42.2 degrees C. Eur J Appl Physiol. 2005;95:298–306.
    1. Gannon GA, Rhind S, Shek PN, Shephard RJ. Naive and memory T cell subsets are differentially mobilized during physical stress. Int J Sports Med. 2002;23:223–9.
    1. Breznitz S, Ben-Zur H, Berzon Y, Weiss DW, Levitan G, Tarcic N, et al. Experimental induction and termination of acute psychological stress in human volunteers: Effects on immunological, neuroendocrine, cardiovascular, and psychological parameters. Brain Behav Immun. 1998;12:34–52.
    1. Marshall GD, Jr, Agarwal SK, Lloyd C, Cohen L, Henninger EM, Morris GJ. Cytokine dysregulation associated with exam stress in healthy medical students. Brain Behav Immun. 1998;12:297–30.
    1. Silvestre R, Cordeiro-Da-Silva A, Santarém N, Vergnes B, Sereno D, Ouaissi A. SIR2-deficient Leishmania infantum induces a defined IFN-gamma/IL-10 pattern that correlates with protection. J Immunol. 2007;179:3161–70.
    1. Fensterl V, Sen GC. Interferons and viral infections. Biofactors. 2009;35:14–20.

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