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102: Changes in expression of cytolitic molecule perforin in peripheral blood lymphocytes after epidural anesthesia in patients with colorectal carcinoma
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102. Changes in expression of cytolitic molecule perforin in peripheral blood lymphocytes after epidural anesthesia in patients with colorectal carcinoma V. Golubovic1, I. Mrakovcic-Sutic2, S. Golubovic1, V. Sotosek-Tokmadzic1, M. Petkovic3 1Department of Anesthesiology and Intensive Therapy, Clinical Hospital Centre Rijeka, University of Rijeka, Rijeka, Croatia, 2Department of Physiology and Immunology; Medical Faculty, University of Rijeka, Rijeka, Croatia, 3Department of Oncology and Radiotherapy, Clinical Hospital Center Rijeka, University of Rijeka, Rijeka, Croatia Background and Aims: The postoperative changes are induced by neuroendocrine, metabolic and immune alteration which are caused by tissue damage, anesthesia, postoperative pain and psychological stress. In postoperative period suppression of immune response was very often. Postoperative pain contributs to dysfunction of immune response as a result of interaction between central nervous and immune systems. The postoperatively activated hypotalamo-pituitary-adrenocortical and sympatoadrenal axis are important modulators of immune response. Afferent neural blockade by epidural analgesia can decrease neuroendocrine stress response. According to bidirectional communication of immune and nervous system, appropriate postoperative pain management could affect immune response in postoperative period. The aim of this study was to examine alteration of cell mediated immunity and cytolytic molecule perforin in different lymphocyte subpopulation in peripheral blood of patient after resection of colorectal carcinoma when postoperative pain may be reduced by epidural analgesia. Methods: Venous blood samples were taken and peripheral blood leukocytes (PBL) were isolated. Phenotype of lymphocytes and perforin expression were analyzed using intracellular and surface immunofluoresecncy and flow cytometric analysis (FACSCalibur). Statistical analysis was done in computer program Statistica 7.1 (StatSoft, Inc., Tulsa, OK, USA). Graphs and tables were done in computer program Microsoft Excel. Results: The results demonstrated that 20-30% of PBL in all examine group are perforin positive (total perforin is significantly higher than in control group). Conclusions: These results suggest that human perforin is differentially expressed in distinct sub-populations of peripheral blood lymphocytes of patients with colorectal carcinoma, indicating that cytotoxic potentials of lymphatic cells are changed during epidural anesthesia. Conclusions: The postoperative pain management by epidural analgesia in patient after colorectal surgery can diminish pain and therefore affect cell mediated immunity, perforin expression and cytotoxic activity of peripheral blood cells. Acknowledgment: This work was supported by grants from the Croatian Ministry of Science (projects: 0620096-0092 and 0620096-0094)
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Postoperative Pain Management
151
119. A comparison of analgesic effect of intraarticular levobupivacaine with bupivacaine following knee arthroscopy Y. Karaman1, C. Kayali2, H. Ozturk2, C. Bor1 1Department of Anaesthesiology, Tepecik Training Hospital, Izmir, Turkey, 2Department of Orthopaedics Surgery, Tepecik Training Hospital, Izmir, Turkey Background and Aims: Levobupivacaine is a new aminoamide local anesthetic. Although chemically related to bupivacaine, studies have shown levobupivacaine to produce less cardiac and central nervous system toxicity. The aim of this study was to compare the analgesic effect of intraarticular levobupivacaine following knee artroscopy. Methods: Forty patients, aged between 20-60 years and undergoing elective knee arthroscopy were enrolled into the study protocol. A standardized general anesthesia including 5-6 mg/kg thiopentalsodium, 0.1 mg/kg vecuronium-bromide i.v. and 1 MAC sevoflurane with 60% N2O in oxygen was administered to all patients. At the end of surgery tha patients were randomly assigned into two groups (n⫽20). Group I received 20 ml 0.5% levobupivacaine and group II received 20 ml 0.5% bupivacaine intraarticularly. Pain scores with Visual Analoque Scale at 1., 2., 4., 6., 12., 24. hours postoperatively, time to the first analgesic requirement and side effects were recorded. Results: Demographic characters were statistically comparable in between 2 groups. There were no significant difference in the postoperative pain scores of the patients between groups. The first analgesic requirement times were not statiscally different. Twelve patients in group I (60%) and 9 patients in group II (45%) needed no additional analgesic during 24 hours (p⬎0.05). No side effect was observed in any patient. Conclusion: The results of the study show that intraarticular 20 ml 0.5% levobupivacaine provides effective analgesia comparable to that provided by 20 ml 0.5% bupivacaine. Key Words: Intraarticular analgesia, Levobupivacaine, Bupivacaine.
102. Changes in expression of cytolitic molecule perforin in peripheral blood lymphocytes after epidural anesthesia in patients with colorectal carcinoma V. Golubovic1, I. Mrakovcic-Sutic2, S. Golubovic1, V. Sotosek-Tokmadzic1, M. Petkovic3 1Department of Anesthesiology and Intensive Therapy, Clinical Hospital Centre Rijeka, University of Rijeka, Rijeka, Croatia, 2Department of Physiology and Immunology; Medical Faculty, University of Rijeka, Rijeka, Croatia, 3Department of Oncology and Radiotherapy, Clinical Hospital Center Rijeka, University of Rijeka, Rijeka, Croatia Background and Aims: The postoperative changes are induced by neuroendocrine, metabolic and immune alteration which are caused by tissue damage, anesthesia, postoperative pain and psychological stress. In postoperative period suppression of immune response was very often. Postoperative pain contributs to dysfunction of immune response as a result of interaction between central nervous and immune systems. The postoperatively activated hypotalamo-pituitary-adrenocortical and sympatoadrenal axis are important modulators of immune response. Afferent neural blockade by epidural analgesia can decrease neuroendocrine stress response. According to bidirectional communication of immune and nervous system, appropriate postoperative pain management could affect immune response in postoperative period. The aim of this study was to examine alteration of cell mediated immunity and cytolytic molecule perforin in different lymphocyte subpopulation in peripheral blood of patient after resection of colorectal carcinoma when postoperative pain may be reduced by epidural analgesia. Methods: Venous blood samples were taken and peripheral blood leukocytes (PBL) were isolated. Phenotype of lymphocytes and perforin expression were analyzed using intracellular and surface immunofluoresecncy and flow cytometric analysis (FACSCalibur). Statistical analysis was done in computer program Statistica 7.1 (StatSoft, Inc., Tulsa, OK, USA). Graphs and tables were done in computer program Microsoft Excel. Results: The results demonstrated that 20-30% of PBL in all examine group are perforin positive (total perforin is significantly higher than in control group). Conclusions: These results suggest that human perforin is differentially expressed in distinct sub-populations of peripheral blood lymphocytes of patients with colorectal carcinoma, indicating that cytotoxic potentials of lymphatic cells are changed during epidural anesthesia. Conclusions: The postoperative pain management by epidural analgesia in patient after colorectal surgery can diminish pain and therefore affect cell mediated immunity, perforin expression and cytotoxic activity of peripheral blood cells. Acknowledgment: This work was supported by grants from the Croatian Ministry of Science (projects: 0620096-0092 and 0620096-0094)
•
Postoperative Pain Management
151
119. A comparison of analgesic effect of intraarticular levobupivacaine with bupivacaine following knee arthroscopy Y. Karaman1, C. Kayali2, H. Ozturk2, C. Bor1 1Department of Anaesthesiology, Tepecik Training Hospital, Izmir, Turkey, 2Department of Orthopaedics Surgery, Tepecik Training Hospital, Izmir, Turkey Background and Aims: Levobupivacaine is a new aminoamide local anesthetic. Although chemically related to bupivacaine, studies have shown levobupivacaine to produce less cardiac and central nervous system toxicity. The aim of this study was to compare the analgesic effect of intraarticular levobupivacaine following knee artroscopy. Methods: Forty patients, aged between 20-60 years and undergoing elective knee arthroscopy were enrolled into the study protocol. A standardized general anesthesia including 5-6 mg/kg thiopentalsodium, 0.1 mg/kg vecuronium-bromide i.v. and 1 MAC sevoflurane with 60% N2O in oxygen was administered to all patients. At the end of surgery tha patients were randomly assigned into two groups (n⫽20). Group I received 20 ml 0.5% levobupivacaine and group II received 20 ml 0.5% bupivacaine intraarticularly. Pain scores with Visual Analoque Scale at 1., 2., 4., 6., 12., 24. hours postoperatively, time to the first analgesic requirement and side effects were recorded. Results: Demographic characters were statistically comparable in between 2 groups. There were no significant difference in the postoperative pain scores of the patients between groups. The first analgesic requirement times were not statiscally different. Twelve patients in group I (60%) and 9 patients in group II (45%) needed no additional analgesic during 24 hours (p⬎0.05). No side effect was observed in any patient. Conclusion: The results of the study show that intraarticular 20 ml 0.5% levobupivacaine provides effective analgesia comparable to that provided by 20 ml 0.5% bupivacaine. Key Words: Intraarticular analgesia, Levobupivacaine, Bupivacaine.