Influence Of PCEA With Buprenorphine On IL-2 And IL-6 In Patients With Gynecological Malignancy

Objective: To compare the clinical effects of patient-controlled epidural analgesia (PCEA) with buprenorphine on postoperative pain and the serum interleukins level (IL-2 and IL-6) in patients with gynecological malignancy.Methods: Thirty ASA I - II patients aged 20-60yr patients with gynecological malignancy undergoing radical correction were selected and randomly divided into two groups (15 patients were concluded in each group): buprenorphine group (group B) and control fentanyl group (group F). PCEA were administrated after surgery. The patients were premedicated with intramuscular sodium 0.15～0.2mg·kg^-1 and atropine 0.5mg; 2% Lidocaine were delivered in succession to all patients under continuous epidural anesthesia. The PCEA solution used was 0.00045% buprenorphine (4.5μg·ml^-1) or 0.0003% fentanyl (3μg·ml^-1) +0.2% bupivacaine. Both solution were attenuated with Sodium Chloride Injection to 150ml. The PCEA settings was: loading dose 2ml (B and F); background infusion 0.05ml·kg^-1h^-1(B and F); PCEA bolus 2ml (B and F); lock-out interval 20 minutes and two groups were all continue 48h. If analgesia was inadequate, buprenorphine 0.075mg or fentanyl 50μg was given when needed. The analgesic effect was assessed by (1) VAS score (2) The number of effective button pressing during the 48h. The incidence of side-effects was recorded. Blood samples were taken from peripheral vein 2h before anesthesia, 1d, 3d and 5d after surgery for determination of serum IL-2 and IL-6 level using enzyme-linked immunosorbent assay (ELISA). Results: There were no significant differences in sex, age, body weight and duration of operation between two groups (P > 0.05). The postoperative analgesia was good in both groups. Compared with that before anesthesia(base line), there was no significant difference in IL-2 (P>0.05) and no difference between the two groups (P>0.05). IL-6 level in both group noticeably raised 2h after surgery compared with base line (P<0.01), gradually decreased 1d and 3d after analgesia comparing with 2h after surgery (P<0.01), but was higher than base line (P<0.05), on the 5th day after surgery essentially recovered to base line (P>0.05); But there was no difference between the two groups(P>0.05).Conclusions: PCEA with buprenorphine and fentanyl both ease or eliminate postoperative pain in patient with gynecological malignancy undergoing radical correction. The two drugs have little effect on serum IL-2 level, but decrease the elevated IL-6 level. Buprenorphine and fentanyl used in patients with gynecological malignancy may alleviate the stress response, attenuate immunosuppression and expedite recovery after surgery.