The Comparative Study Of Immune Function Between Local Anesthesia And Continuous Epidural Anesthesia For Inguinal Hernia Tension-free Repair

Objective: By comparing the immune function between local anesthesia and continuous epidural anesthesia for inguinal hernia tension-free repair,to explore the anesthesia method which generates less impact of immunization.The surgeon and anesthesiologists can choose of more appropriate anesthesia referencing this study.Methods: A total of 60 male patients with unilateral inguinal hernia in the Second Hospital of Hebei Medical University during January 2015 to June2015 participated this study. According to different anesthesia methods these patients were randomly divided into local anesthesia group(n=30 cases) and continuous epidural anesthesia group(n=30 cases). Surgical methods were tension-free inguinal hernia repair(Millikan).Hernia repair materials used Italian Herniamesh hernia patch. Comparison of index variation of the two groups was observed at preoperative 30min(T0), postoperative first day(T1)and postoperative third day(T2). Monitoring indicators: white blood cell(WBC), lymphocyte(LY), interleukin-6(IL-6), tumor necrosis factor ?(TNF-?).WBC and LY were measured in VCS technology by automatic hematology analyzer,and IL-6 and TNF-? were measured by double antibody sandwich enzyme-linked immunosorbent assay(ELISA).Test data was analyzed by SPSS19.0. P<0.05 is considered statistically significant.Results:At preoperative 30min(T0) WBC level between local anesthesia group and continuous epidural anesthesia group [(6.89±1.82)×109/L vs.(6.84±2.01)×109/L;P=0.940] is no statistical significance(P>0.05).At postoperative first day(T1) WBC level is significantly higher than that at preoperative30 min, Between the two groups local anesthesia group was lower than continuous epidural anesthesia group [(10.79±1.96)×109/L vs.(12.37± 2.44)×109/L;P=0.034],the difference is statistically significant(P<0.05); WBC level at postoperative third day(T2) declines compared with that at postoperative first day(T1),but still higher than that at preoperative 30 min. At postoperative third day(T2) WBC level between local anesthesia group and continuous epidural anesthesia group[(8.77± 2.47)×109/L vs.(9.21±2.56)×109/L;P=0.602]is no statistical significance(P>0.05).At preoperative 30min(T0) LY level between local anesthesia group and continuous epidural anesthesia group[(1.85±0.73)×109/Lvs.(1.99±0.78)×109/L;P=0.592]is no statistical significance(P>0.05).At postoperative first day(T1) LY level is significantly lower than that at preoperative 30 min, Between the two groups local anesthesia group was higher than continuous epidural anesthesia group[(1.32±0.47)×109/L vs.(1.02±0.27)×109/L; P=0.029],the difference is statistically significant(P<0.05); LY level at postoperative third day(T2) increases compared with that at postoperative first day(T1),but still lower than that at preoperative30 min. At postoperative third day(T2) LY level between local anesthesia group and continuous epidural anesthesia group[(1.74±0.60)×109/Lvs.(1.61±0.44)×109/L;P=0.592]is no statistical significance(P>0.05).At preoperative30min(T0) IL-6 level between local anesthesia group and continuous epidural anesthesia group[(387.64±34.80)pg/mLvs.(371.43±19.94)pg/mL;P=0.337],is no statistical significance(P>0.05). At postoperative first day(T1) IL-6 level of local anesthesia group is lower than that at preoperative 30 min.And IL-6level of continuous epidural anesthesia group doesn't decline. At postoperative first day(T1)IL-6 level between local anesthesia group and continuous epidural anesthesia group[(330.57 ± 27.99)pg/mLvs.(338.03 ± 31.20)pg/mL;P=0.658], is no statistical significance(P>0.05). At postoperative third day(T2) IL-6 level both of two groups is significantly lower than that at postoperative first day. Between the two groups local anesthesia group is higher than continuous epidural anesthesia group[(287.14±22.21)pg/mL vs.(254.94 ± 23.88)pg/mL;P=0.037], the difference is statistically significant(P<0.05).At preoperative 30min(T0) TNF-? level between local anesthesia group and continuous epidural anesthesia group[(56.16 ± 5.29)pg/mLvs.(52.25 ± 4.76)pg/mL;P=0.192], is no statistical significance(P>0.05). At postoperative first day(T1) TNF-? level is significantly lower than that at preoperative 30 min. At postoperative first day(T1)TNF- ? level between local anesthesia group and continuous epidural anesthesia group[(48.28 ±5.12)pg/mL vs.( 45.76±4.88) pg/mL;P=0.386],is no statistical significance(P>0.05). At postoperative third day(T2) TNF-? level both of two groups is significantly lower than that at postoperative first day. At postoperative third day(T2) TNF- ? level between local anesthesia group and continuous epidural anesthesia group[(40.73 ± 4.45)pg/mLvs.(34.32 ± 6.52)pg/mL; P=0.069],is no statistical significance(P>0.05).Conclusion: The impact of local anesthesia on immune function is smaller than that of continuous epidural anesthesia in comparison on the indicators of WBC, LY and IL-6.And two anesthesia on the indicator of TNF-? is no significance. Local anesthesia is better than continuous epidural anesthesia in simplicity and postoperative recovery.Local anesthesia can be used as a preferred anesthetic of inguinal hernia tension-free repair.