The Effect Of Combined General-epidural Anesthesia And Postoperative Epidural Analgesia On Immune Function Of Patients With Gastric Cancer

Objective To investigate the effects of epidural block and epidural analgesia on immune function of patients with gastric cancer. Methods Thirty-six ASA I — II patients undergoing elective radical operation for gastric cancer, were randomly assigned into three groups(n=12).Group I : Anaesthesia was induced with fentanyl 2~4 μg/kg, midazolam 0.1~0.2mg/kg, atracrium 0.6mg/kg, propofol 1~ 2mg/kg, and maintained with intermittent intravenous bolus of atracrium propofol and inhalation of isoflurane. Group II: The patients received an epidural catheter inserting by the sit of T8~9 before general anesthesia, and infused 0.25%bupivacaine(5 ~ 8ml/h) intermittently through the epidual catheter during the period of anesthesia.The induction was the same as in group I, and maintained with propofol infusion 1~2mg/kg/h and inhalational isoflurane 0.3 ~ 0.5MAC.Group III:The induction and maintaince of anaesthesia were the same as in group II .After operation, PCEA with 0.15% bupivacaine and 0.004%fentanyl was started .Peripheral blood samples were taken before induction of anesthesia(T0) at the end of operation(T1) and on the first (T2),the third(T3),the fifth(T4) and the seventh (T5) day after operation to measure T-lymphocyte subsets (CD3+,CD4+,CD8+, CD4+/ CD8+),and CD19+ B-lymphocyte cells as well as natural kill cell counts by flow cytometry (FACScalibur E4242 USA).Results There were no significant differences in age body weight ASA class and surgical duration among the three groups. CD3+,CD4+,CD8+andCD4+/ CD8+decreased significantly at the end of operation and the first postoperative day in three groups compared with those at base line(P<0.05),In groupIII and II. CD3+,CD4+,CD8+andCD4+/ CD8+almost returned to baseline values on the third fifth postoperative day respectively. In group I CD3+,CD4+,CD8+,andCD4+/CD8+ were close to baseline values on the seventh postoperative day. On the fifth postoperative day, CD3+,CD4+,CD8+andCD47 CD8+were significantly higher in groupIII than those in group I ( P<0.05).The NK cell counts began to decrease strikingly from the end of operation to the fifth postoperative day in group I whereas the decrease began from the first day to the third day after operation in group II .The NK cells recovered on the fifth and third postoperative day in group II and III ,but on the seventh day after operation in group I .On the fifth postoperative day NK cell counts were notable higher in groupIII than that in group I (P<0.05). Conclusion Perioperative epidural anesthesia and epidural analgesia of post-operation combined with general anesthesia can improve the immunosuppression of the gastric cancer patients, which could promote the recovery of patient's immune function.