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PAIN MEDICINE

The Effects of Postoperative Pain Management on Immune Response to Surgery

Benzion Beilin, MD^*, Yehuda Shavit, PhD, Evelyn Trabekin, MD, Boris Mordashev, MD^*, Eduard Mayburd, MD^*, Alexander Zeidel, MD^*, and Hanna Bessler, PhD

*Department of Anesthesiology and Research Institute, Rabin Medical Center, Golda-Hasharon Campus, affiliated with the Sackler School of Medicine, Tel-Aviv University; Department of Anesthesiology, Schneider Children’s Medical Center, Petah Tiqva; and Department of Psychology, Hebrew University, Jerusalem, Israel

Address correspondence and reprint requests to Yehuda Shavit, PhD, Department of Psychology, Hebrew University, Jerusalem 91905, Isreal. Address e-mail to Udi.Shavit{at}huji.ac.il

Surgery is associated with immune alterations, which are the combined result of tissue damage, anesthesia, postoperative pain, and psychological stress. In the present study, we compared the effects of several postoperative pain management techniques on postoperative immune function. Patients hospitalized for abdominal surgery were randomly assigned to one of three postoperative pain management techniques: opiates on demand (intermittent opiate regimen [IOR]), patient-controlled analgesia (PCA), and patient-controlled epidural analgesia (PCEA). Postoperative pain was assessed. Blood samples were collected before and 24, 48, and 72 h after surgery. Production of interleukin (IL)-1ß, IL-2, and IL-6, natural killer cell cytotoxicity, and lymphocyte mitogenic responses were assessed. Patients of the PCEA group exhibited lower pain scores in the first 24 h after surgery compared with patients of the IOR and PCA groups. Mitogenic responses were suppressed in all groups in the first 24 h, returned to preoperative values by 72 h in the PCEA group, but remained suppressed in the PCA group. Production of IL-1ß and IL-6 increased in the IOR and PCA groups, whereas it remained almost unchanged in the PCEA group. Patients receiving an epidural mixture of opiate and local anesthetics (PCEA group) exhibited reduced suppression of lymphocyte proliferation and attenuated proinflammatory cytokine response in the postoperative period.

IMPLICATIONS: The present study compared the effects of three pain management techniques, intermittent opiate regimen, patient-controlled analgesia, and patient-controlled epidural analgesia on several immune functions. Patients of the patient-controlled epidural analgesia group exhibited reduced postoperative pain, reduced suppression of lymphocyte proliferative response to mitogens, and attenuated proinflammatory cytokine response to surgery.

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