Table 2.A.
The relationship between combined general and regional or neuraxial anesthesia/analgesia and general anesthesia alone (including postoperative intravenous opiate analgesia) on the postoperative systemic inflammatory response in patients undergoing different types of surgery in the context of a randomized controlled trial
| Author (s) | Country | Type of surgery | Severity of surgery | Patients (n) |
Anesthetics used | Inflammatory response marker | Post-operative sampling point | Findings | Comments | Quality of study |
|---|---|---|---|---|---|---|---|---|---|---|
| [35] | Denmark | Coronary artery bypass grafting surgery. | Major | 16 | Group I = TEA‡ combined with inhalational anesthesia. Group II = high dose fentanyl group. |
IL-6⁎ | 24 h | Group I, IL-6 = 200 pg/mL. Group II = IL-6 = 230 pg/mL. |
No significant difference between groups. | Low range of quality score. |
| CRP† | 48 h | Group I, CRP = 132 mg/L (± 17.4) Group II = CRP = 150 mg/L (± 13) |
No significant difference between groups. | |||||||
| [36] | Japan | Esophageal cancer. | Major | 30 | Group E = GA§ with continuous epidural infusion for postoperative analgesia compared with group G = intraoperative GA and postoperative IV morphine infusion. | IL-6 | 24 h | Group E, 24 h, IL-6 = 310 pg/mL Group G, 24 h, IL-6 = 330 pg/mL |
No significant difference between groups. | Low range of quality score. |
| CRP | 24 and 72 h | Group E, 24 h, CRP = 90 mg/L 72 h, CRP = 100 mg/L Group G, 24 h, CRP = 70 mg/L 72 h, CRP = 100 mg/L |
No significant difference between groups. | |||||||
| [30] | Taiwan | Colon cancer. | Moderate | 60 | Thoracic epidural analgesia with lidocaine compared with IV infusion with lidocaine and control group. | IL-6 | 12 h | Control,12 h, IL-6 = 29 pg/mL, P < .0001 TEA, 12 h, IL-6 = 14 pg/mL, P < .0001 IV group, 12 h, IL-6 = 20 pg/mL, P < .0001 |
Significant reduction in IL-6 in TEA group versus other groups and IV group was better than the control group. | Low range of quality score. |
| [33] | Netherlands | Coronary artery bypass surgery. | Major | 60 | AG = alfentanil group HDRG = high-dose remifentanil group. LDRG = low-dose remifentanil group. TEA = thoracic epidural analgesia in combination with propofol-TCI technique. |
IL-6 | 18 h | AG, IL-6 = 0.18 pg/mL, P = .006 HDRG, IL-6 = 0.14 pg/mL, P = .006 LDRG, IL-6 = 0.15 pg/mL, P = .006 TEA, IL-6 = 0.46 pg/mL, P = .006 |
Significant increase in IL-6 in TEA group versus other groups. | Low range of quality score. |
| CRP | 24,48 and 72 h | AG, 24 h, CRP = 80 mg/L 48 h, CRP = 170 mg/L 72 h, CRP = 120 mg/L HDRG, 24 h, CRP = 70 mg/L 48 h, CRP = 180 mg/L 72 h, CRP = 120 mg/L LDRG, 24 h, CRP = 80 mg/L 48 h, CRP = 220 mg/L 72 h, CRP = 145 mg/L TEA, 24 h, CRP = 50 mg/L 48 h, CRP = 200 mg/L 72 h, CRP = 135 mg/L |
No significant difference between groups. | |||||||
| [47] | Spain | Coronary artery bypass graft surgery with cardiopulmonary bypass. | Major | 22 | GA = GA with postop IV morphine infusion TEA with bupivacaine combined with GA. |
CRP | 24 and 36 h | GA, 24 h, CRP = 200 mg/L, P = .047 36 h, CRP = 250 mg/L TEA, 24 h, CRP = 160 mg/L, P = .047 36 h, CRP = 200 mg/L |
Significant reduction in CRP in TEA group versus GA group. | High range of quality score. |
| [48] | Greece | Abdominal colectomy. | Major | 40 | Group G = GA with postop PCA# Group C = GA combined with epidural analgesia. |
CRP | 24 h | Group G, 24 h, CRP = 120.40 mg/L (125.53 ± 35.03) Group C, 24 h, CRP = 139 mg/L (133.87 ± 34.65), P = .045 |
Significant increase in CRP in group C versus group G. | Low range of quality score. |
| [37] | Italy | Colon cancer. | Moderate | 35 | IEA = GA with intraoperative epidural analgesia compared with IA = GA with IV analgesia. | IL-6 | 24 h | IEA, 24 h, IL-6 = 173.5 pg/mL. IA, 24 h, IL-6 = 171.2 pg/mL. |
No significant difference between groups. | Low range of quality score. |
| [38] | Turkey | Renal transplantation surgery. | Major | 46 | Group I = GA alone. Group II = EA || combined with GA. |
IL-6 | 24 h | Group I, 24 h, IL-6 = 80 pg/mL, P < .05 Group II, 24 h, IL-6 = 50 pg/mL, P < .05 |
Significant reduction in IL-6 in group II versus group I. | Low range of quality score. |
| [39] | Lithuania | Laparoscopic colorectal surgery. | Moderate | 53 | GA compared with combined GA with EA. | IL-6 | 24 h | GA, 24 h, IL-6 = 52.2 (197.56) pg/mL. EA, 24 h, IL-6 = 61.78 (215.31) pg/mL. |
No significant difference between groups. | Low range of quality score. |
| CRP | 24 and 48 h | GA, 24 h, CRP = 128.6 (0) mg/L 48 h, 62.07 (66.43) mg/L EA, 24 h, CRP = 64 (38.47) mg/L 48 h, 42.62 (26.98) mg/L |
No significant difference between groups. | |||||||
| [40] | Philadelphia | Major spinal surgery. | Major | 85 | Group E = EA and endotracheal anesthesia with sevoflurane during surgery and continuous epidural analgesia with ropivacaine, fentanyl and epinephrine after surgery. Group G = GA with sevoflurane and fentanyl and systemically administered opioids after surgery. |
IL-6 | 24 h | Group E, 24 h, IL-6 = 9 pg/mL Group G, 24 h, IL-6 = 12 pg/mL |
No significant difference between groups. | Low range of quality score. |
| [41] | Sweden | Radical retro- pubic prostatectomy. | Moderate | 26 | Group E = PCEA⁎⁎ received epidural analgesia using LA¶ during operation and a combination of LA and opioids after operation. Group P = PCIA# has IV opioid-based analgesia. |
IL-6 | 24 h | Group E, 24 h, IL-6 = 35.7 pg/mL, P = .953 Group P, 24 h, IL-6 = 29.1 pg/mL, P = .953 |
No significant difference between groups. | Low range of quality score. |
| CRP | 24 and 72 h | Group E, 24 h, CRP = 69 (36) mg/L, P = .907 72 h, CRP = 98 (68) mg/L, P = .515 Group P, 24 h, CRP = 67 (25) mg/L, P = .907 72 h, CRP = 112 (32) mg/L, P = .515 |
No significant difference between groups. | |||||||
| [42] | Egypt | Ivor Lewis esophagectomy | Major | 30 | Group I = GA and postoperative PCA# morphine Group II = Thoracic epidural analgesia combined with GA. |
IL-6 | 20 h | Group I, 20 h, IL-6 = 80.6 ± 13.7, P = .033 Group II, 20 h, IL-6 = 55.2 ± 24.6, P = .033 |
Significant reduction in IL-6 in group II versus group I. | Low range of quality score. |
| [43] | China | Colon cancer. | Moderate | 40 | PEA = Thoracic propofol epidural anesthesia GA with PCA IV sufentanil |
IL-6 | 24 h | TPEA, 24 h, IL-6 = 26.75 (6.84) pg/mL, P = .007 GA, 24 h, IL-6 = 33.60 (8.32) pg/mL, P = .007 |
Significant reduction in IL-6 in TPEA versus GA group. | Low range of quality score. |
| [31] | UK | Laparoscopic colorectal surgery. |
Moderate | 120 | PCA compared with spinal analgesia. | IL-6 | 24 h | PCA, 24 h, IL-6 = 58 pg/mL, Spinal, 24 h, IL-6 = 42 pg/mL |
No significant difference between groups. | Low range of quality score. |
| [49] | China | Colon cancer. | Moderate | 53 | G = GA with postoperative PCIV opiate E = GA combined with EA. |
CRP | 48 h | GA,48 h, CRP = 90 mg/L, P < .01 Epidural, 48 h, CRP = 65 mg/L, P < .01 |
Significant reduction in CRP in EA group versus GA group. | Low range of quality score. |
| [44] | China | Esophageal carcinoma undergoing thoracic surgery. | Major | 57 | Group I = GA + PCIA Group II = GA + PCEA Group III = GA + TEA + PCIA Group IV = GA + TEA + PCEA |
IL-6 | 24 h | Group I, 24 h, IL-6 = 140 ± 56.3 pg/mL, P = .46 Group II, 24 h, IL-6 = 128.7 ± 29.7 pg/mL, Group III, 24 h, IL − 6 = 130 ± 29.8 pg/mL, P = .46 Group IV, 24 h, IL-6 = 117.3 ± 25.5 pg/mL, P = .46 |
No significant difference between groups. | Low range of quality score. |
| [50] | Greece | Laparoscopic cholecystectomy. |
Minor | 60 | GA compared with lumbar epidural anesthesia and GA. | CRP | 24 h | GA, 24 h, CRP = 49.68 ± 19.69 mg/L EGA, 24 h, CRP = 48.15 ± 11.73 mg/L |
No significant difference between groups. | High range of quality score. |
| [45] | Egypt | Major abdominal surgery. | Major | 80 | Group I = combined TIVA with TEA. Group II = GA with TIVA†† |
IL-6 | 24 h | Group I, IL-6, 24 h = 58 ± 16.59 pg/mL, P = .033 Group II, IL-6, 24 h = 66.93 ± 20.06 pg/mL, P = .033 |
Significant reduction in IL-6 in group I versus group II. | Low range of quality score. |
| [34] | Turkey | Laparoscopic cholecystectomy. |
Minor | 60 | TEA = combination of GA and thoracic epidural analgesia divided into four groups: Group S = saline, Group F = fentanyl, Group B = bupivacaine and group L = levobupivacaine were infused with saline, saline and fentanyl, bupivacaine and fentanyl, and levobupivacaine and fentanyl, respectively via epidural catheter before surgical incision. | IL-6 | 24 h | Group S, 24 h, IL-6 = 17 pg/mL Group F, 24 h, IL-6 = 17 pg/mL Group B, 24 h, IL-6 = 15 pg/mL Group L, 24 h, IL-6 = 14 pg/mL. |
No significant difference between groups. | Low range of quality score. |
| [32] | China | Minimally invasive mitral valve surgery. | Major | 30 | Group A = patients received intercostal nerve block combined with GA. Group B = patients received GA alone. |
IL-6 | 24 h | Group A, 24 h, IL-6 = 1300 pg/mL, P < .001 Group B, 24 h, IL-6 = 2200 pg/mL, P < .001 |
Significant reduction in IL-6 in group A versus group B. | Low range of quality score. |
| [46] | Egypt | Coronary artery bypass graft surgery. | Major | 88 | GA = GA alone. TEA + GA = thoracic epidural analgesia combined with GA. |
IL-6 | 24 h | GA, 24 h, IL-6 = 41.38 pg/mL TEA + GA, 24 h, IL-6 = 31.7 pg/mL |
Significant reduction in IL-6 in TEA combined with GA group versus GA group. | High range of quality score. |
⁎
IL-6, Interleukin 6; † CRP, C-reactive protein; ‡ TEA, thoracic epidural anesthesia; § GA, general anesthesia; || EA, epidural anesthesia; ¶ LA, local anesthesia; # PCIA/PCA, patient-controlled intravenous analgesia; ⁎⁎ PCEA, patient-controlled epidural analgesia; †† TIVA, total intravenous anesthesia.