The Effect Of Lappaconitine Postoperative Analgesia On Plasma β-EP,SP And Serum TNF-α,IFN-γ,IL-2 In Cancer Patients Undergoing Esophageal Surgery

Objectives: The effects of lappaconitine postoperative analgesia on the plasma β－EP ,SP and serum TNF-α, IFN－γ, IL-2 were studied in 45 patients.Methods: Forty-five patients, ASA gradeⅡ-Ⅲ,who were scheduled for esophageal carcinoma entered the study. All patients were otherwise healthy without sign of hepatic, renal, endorcrinologic, immunologic, severe cardiac and pulmonary diseases. No radiotherapeutic and chemotherapeutic medications were taken, and no sign of infection was observed within 2 weeks before operation. According to postoperative analgesia methods, 45 patients were randomly divided into 3 groups: A group received on-demand pethidine 50mg; B group received continuous lappaconitine; In group C, postoperative analgesia was produced with epidural lappaconitine + bupivacaine. All patients were premedicated with diazepam 0.2 mg/kg,atropine 0.01 mg/kg or scopolamine 0.3 mg/kgintramuscularly. Thoracic epidural catheters was placed in the epidural space between T7 and T8 or T8 and T9. A 4ml test dose of 1.5% lidocaine was then administered through the epidural catheter to confirm epidural placement of the catheter. After a successful test dose, anesthesia was induced with IV fentanyl 2-4 μg/kg, imidazoline 0.1-0.3 mg/kg and rocuronium 0.6-0.8 mg/kg. Then the trachea was intubated and the general anesthesia was maintained with 2%-5% isoflurane or vecuronium, further increments of fentanyl 50-100μg as required to keep anesthesia depth. SBP, DBP, MAP, HR, SpO2 were monitered before and during operation. Group B received continuous lappaconitine 3.5 mg/kg for 48 hour intravenously. In group C, postoperative analgesia was produced with epidural lappaconitine 16 mg + 0.75% bupivacaine 45mg for 48 hour. Blood samples were taken form peripheral vein before anesthesia, at the end of surgery and 6,24,48 hour post-operation for determination of plasma β－EP and SP by RAID. Pain was assessed by a visual analog scale at 6, 24,48 hour after surgery and side effects were also recorded. Other samples were taken before anesthesia, at the end of operation at 24, 48, 120 hour post-operation to determine serum TNF-α, IFN-γ, IL-2 by RAID or ELISA.Results: (1)MAP in group A, B, C increased unsignificantly at the end of surgery, 6,24 hourpost-operation compared to pre-operative level. HR in group A increased significantly at the end of surgery, 6,24,48 hour post-operation compared to pre-operative level and but not higher markedly than that in group B and C. (2) VAS scale in group B or C was lower markedly than that in group A at 6,24,48 hour after operation. VAS scale in group C was lower markedly than that in group B. Satisfactory pain relief achieved similarly in group B and C, but not in group A.(3) β- EP level increased significantly at the end of surgery compared to pre-operation in each group, but it was lower in group B and C than group A at 6, 24 ,48 hour post-operation. serum SP level remained unsignificant change in three groups.(4) serum TNF-αin group A increased significantly at 24 ,48 hour post-operation compared to pre-operative levelbut not in group B and C, and higher than those in group B and C.serum IL-2 in group A increased significantly at the end of surgery, 24, 48 hour post-operation compared to pre-operative level. It was lower in group B and C at the end of surgery than that of pre-operation, and lower in group B and C at 24, 48 hour post-operation than that in group A.serum IFN－γlevel remained unsignificant change in three groups.Conclusion: 1. As a Chinese medicine, lappaconitine can reduce postoperative pain via epidural ＋bupivacaine or intravenous infusion, but the VAS score between them was different significantly. 2. β－EP levels increased markly after surgery, which indicated that surgical trauma can induce intensive stress response, but effective analgesia can lower its level. 3. Cytokine play an important role in stress response, postoperative pain relief provided by lappaconitine can modulate the release...