Effect of thoracic epidural analgesia on proinflammatory cytokines in patients subjected to protective Lung Ventilation During Ivor Lewis Esophagectomy

Background: thoracic epidural analgesia (tea) has a well-known effect on neurohormonal response. attenuation of stress response by post-operative epidural analgesia has shown beneficial effects such as lower pain scores and less immunological alterations. objectives: investigation of the combined effects of tea and protective lung ventilation on proinflammatory cytokines and patients' outcome after ivor lewis esophagectomy. study design: a randomized controlled study. setting: academic medical center. methods: thirty patients of the american society of anesthesiologists (asa) i and ii were randomly allocated into 2 groups: g1 (n = 15) patients received general anesthesia and were mechanically ventilated with 9 ml/kg during 2 lung ventilations,reduced to 5 ml/kg and 5cm h2o positive end expiratory pressure (peep) during one lung ventilation (olv) or gii) (n = 15) patients received tea and the same general anesthesia and mechanical ventilation used in g1. assessment parameters included hemodynamics,pain severity,total analgesic consumption,and measurement of interleukins (il) (il-6 and il-8) at baseline time after anesthetic induction (tbaseline,); at the end of the abdominal stage of the operation (tabdo,); 15 minutes after initiation and at the end of olv (tolv 15) and (tolv end) respectively; one and 20 hours after the end of the surgical procedure (tpostop1 and tpostop20),respectively,and patient's outcome also recorded. results: there was a significant reduction in mean arterial blood pressure (map) and pulse rate in gii during the intraoperative period,at tabdo,tolv15,and tolv end (p < 0.05). the mean of systolic blood pressure (sbp) values were significantly lower in gii over all 3 post-operative days (p = 0.001),and the mean diastolic blood pressure (dbp) showed a significant reduction in gii for 16 hours post-operatively (p = 0.001). the mean of heart rate values showed a significant reduction in gii over all 3 post-operative days in comparison to gi (p = 0.001). the mean resting and dynamic vas scores were significantly reduced in gii at all time periods studied in comparison to g1 (p = 0.001). the daily pca morphine consumption was markedly decreased in gii compared to gi in the first 3 days post-operatively (p = 0.001). there were significant reductions in blood level of il-6 and il-8 in gii compared to g1 over the entire study period (p < 0.05). there were no significant differences in post-operative adverse effects between the 2 groups (p > 0.05). the duration of stay in pacu was significantly decreased in gii (10 ± 2 days) compared to gi (15 ± 3 days) (p = 0.001). limitations: this study is limited by its sample size. conclusion: our study concluded that tea reduced the systemic pro-inflammatory response and provided optimal post-operative pain relief. although there were no significant differences in adverse events,there was a trend towards improved outcome. further clinical studies with larger numbers of patients are required.