Effects Of Anesthetic Technique On Serum VEGF-C And PGE₂in Women Undergoing Surgery For Uterine Leiomyomas

Objective To assess the effect of spinal anesthesia (SA) with postoperative continuousepidural analgesia and general anesthesia (GA) with patient controlled intravenous analgesiaon serum vascular endothelial growth factor C (VEGF-C) and prostaglandin E2(PGE2) afterthe surgery of myomectomy or hysterectomy.Methods Fifty women with leiomyomas undergoing surgery of myomectomy orhysterectomy were randomized to receive either standard SA or GA technique. Venous bloodsamples were taken before anesthesia induction and at48h after surgery. VEGF-C and PGE2were analyzed in the serum using enzyme linked immunosorbent assay (ELISA). The primaryendpoint was SA versus GA on postoperative change in serum VEGF-C and PGE2concentrations. Pain assessment was assessed at2h,4h,8h,12h,24h and48h after surgery byusing the visual analog scale (VAS) pain score.Results The age, ASA physical status, weight and height, or patient characteristics anddetails on leiomyomas and surgical factors were no significant differences between the twogroups. The concentrations (mean±SD) of serum VEGF-C no statistical significance(P=0.621) at the preoperative between the SA group (372±37pg/ml) and GA group(375±53pg/ml), which were decrease at48h after the surgery (P=0.0001). There wasstatistically difference between SA group (206±47pg/ml) and GA group (293±45pg/ml) at48h after the surgery on VEGF-C (P=0.0001). The concentrations (mean±SD) of serumPGE2is no statistical significance (P=0.767) at the preoperative between the SA group (381±32pg/ml) and GA group (383±24pg/ml), which were decrease at48h after the surgery (P= 0.0001). Static visual analog scale (VAS) pain scores (median [25–75%interquartile range])were1[0-1],1[0-1],1[0-2],1.5[0-2],0[0-1],0[0-0] for SA patients at2h,4h,8h,12h,24h and48h respectively, and for GA patients were5[3-6],5[4-6],5[3-6],4[3-5],3[2-4],2[1-2],respectively. The patients in SA group had less pain than the patients in GA group(P=0.0001).Conclusion Removal of uterine leiomyomas by surgery and anesthesia can reduce theconcentration of serum VEGF-C and PGE2. The decrease of serum VEGF-C was greater inSA group than that in the group GA for leiomyomas patients.