caa a22 4500 445335513 CHVBK 20180317142753.0 cr unu---uuuuu 170323e20111001xx s 000 0 eng 10.1245/s10434-011-1700-9 doi (NATIONALLICENCE)springer-10.1245/s10434-011-1700-9 Intraoperative Epidural Analgesia Prevents the Early Proinflammatory Response to Surgical Trauma. Results from a Prospective Randomized Clinical Trial of Intraoperative Epidural Versus General Analgesia [Elektronische Daten] [Nora Moselli, Elisa Baricocchi, Dario Ribero, Antonio Sottile, Luisa Suita, Felicino Debernardi] Background: The intraoperative epidural analgesia (EA) has the potential to reduce stress response to surgical trauma which induces a transient immunoactivation that has a negative impact on the outcome. This study investigates the effect of intraoperative EA versus intravenous analgesia (IA) on the immune function. Methods: A total of 35 consecutive patients candidated to undergo major surgery for colon cancer were randomly assigned to intraoperative EA (n=18) or IA (n=17). Blood samples for TNF-α, IFN-γ, IL-1, IL-2, IL-4, IL-6, IL-10, IL-12, and GM-CSF were obtained before surgery (Tpre), 3h (T3h), and 24h (T24h) after skin incision. Data on postoperative complications were prospectively collected and analyzed. Results: In the EA group, IL-4 increased from Tpre to T3h and from T3h to T24h, IL-10 increased from Tpre to T3h and persisted unmodified thereafter. At all time-points, IL-4 and IL-10 serum levels were significantly higher than those in the IA group. Conversely, in the IA group, IL-4 and IL-10 serum levels did not change while all other cytokines levels were significantly higher compared with the EA group. In particular, IL-6 progressively reached a 7-fold increase of its basal value at T24h. Complications were significantly more common in IA patients (13 of 17) compared with EA patients (7 of 18) (P=.024). Conclusions: Our results indicate that in cancer patients undergoing major elective colon surgery, the EA attenuates the surgery-induced proinflammatory response and the typical postoperative transient immunosuppression and seems associated with a reduced rate of postoperative complications compared with IA. Society of Surgical Oncology, 2011 Moselli Nora Department of Anesthesiology, Intensive Care and Pain Therapy, IRCC—Institute for Cancer Research and Treatment, Candiolo, Italy aut Baricocchi Elisa Department of Anesthesiology, Intensive Care and Pain Therapy, IRCC—Institute for Cancer Research and Treatment, Candiolo, Italy aut Ribero Dario Division of Hepato-Biliary-Pancreatic and Digestive Surgery, Ospedale Mauriziano "Umberto I”, Torino, Italy aut Sottile Antonio Analysis Laboratory, IRCC—Institute for Cancer Research and Treatment, Candiolo, Italy aut Suita Luisa Department of Anesthesiology, Intensive Care and Pain Therapy, IRCC—Institute for Cancer Research and Treatment, Candiolo, Italy aut Debernardi Felicino Department of Anesthesiology, Intensive Care and Pain Therapy, IRCC—Institute for Cancer Research and Treatment, Candiolo, Italy aut Annals of Surgical Oncology Springer-Verlag 18/10(2011-10-01), 2722-2731 1068-9265 18:10<2722 2011 18 10434 https://doi.org/10.1245/s10434-011-1700-9 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1245/s10434-011-1700-9 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Moselli Nora Department of Anesthesiology, Intensive Care and Pain Therapy, IRCC—Institute for Cancer Research and Treatment, Candiolo, Italy aut NATIONALLICENCE 700 1- Baricocchi Elisa Department of Anesthesiology, Intensive Care and Pain Therapy, IRCC—Institute for Cancer Research and Treatment, Candiolo, Italy aut NATIONALLICENCE 700 1- Ribero Dario Division of Hepato-Biliary-Pancreatic and Digestive Surgery, Ospedale Mauriziano "Umberto I”, Torino, Italy aut NATIONALLICENCE 700 1- Sottile Antonio Analysis Laboratory, IRCC—Institute for Cancer Research and Treatment, Candiolo, Italy aut NATIONALLICENCE 700 1- Suita Luisa Department of Anesthesiology, Intensive Care and Pain Therapy, IRCC—Institute for Cancer Research and Treatment, Candiolo, Italy aut NATIONALLICENCE 700 1- Debernardi Felicino Department of Anesthesiology, Intensive Care and Pain Therapy, IRCC—Institute for Cancer Research and Treatment, Candiolo, Italy aut NATIONALLICENCE 773 0- Annals of Surgical Oncology Springer-Verlag 18/10(2011-10-01), 2722-2731 1068-9265 18:10<2722 2011 18 10434 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer