Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2020.04.017
Brazilian Journal of Anesthesiology
Scientific Article

Impact of post-thoracotomy analgesia with dexmedetomidine and morphine on immunocytes: a randomized clinical trial

Impacto da analgesia pós-toracotomia com dexmedetomidina e morfina em imunócitos: estudo randomizado

Pengfei Lei, Jin Wang, Shan Gao, Du Bo, Hao Wang, Weichun Li, Fei Shi, Aijun Shan

Downloads: 0
Views: 46

Abstract

Objective
This study aimed to investigate the impact of post-thoracotomy analgesia with dexmedetomidine and morphine on immunocytes.

Methods
A total of 118 patients with post-thoracotomy Patient-Controlled Intravenous Analgesia (PCIA) in our hospital from March 2016 to July 2018 were randomly selected and divided into the Composite (COM) Group (57 patients administered with dexmedetomidine [1.0 μg.kg-1 body weight] and morphine [0.48 mg.kg-1 body weight]) and the Morphine (MOR) group (61 patients administered with morphine [0.48 mg.kg-1]). The values of lymphocyte subsets (CD3+, CD4+, and CD8+) and Natural Killer cells in the peripheral blood of these two groups were detected by FACSCalibur flow cytometry at different time points (before anesthesia induction [T0], immediately after tracheal extubation [T1], 12 hours after surgery [T2], 24 hours after surgery [T3], 48 hours after surgery [T4], 72 hours after surgery [T5], and 7 days after surgery [T6]). The doses of morphine at T3 to T5 and the adverse reactions between the two groups were also recorded and compared.

Results
The CD3+ level and the CD4+/CD8+ ratio at T2 to T5 and the CD4+ level and NK cells at T3 to T5 were significantly higher in the COM Group than in the MOR Group (p< 0.05). The postoperative morphine dose and the incidence of postoperative itching, nausea, and vomiting were significantly lower in the COM Group than in the MOR Group (p< 0.05).

Conclusions
Dexmedetomidine combined with morphine for post-thoracotomy PCIA can improve the function of immunocytes, reduce morphine consumption, and reduce the adverse reactions during analgesia induction.

Keywords

Thoracotomy;  Dexmedetomidine;  Morphine;  Analgesia;  Immunocytes

Resumo

Objetivo
Estudar o impacto em linfócitos causado pelo uso da dexmedetomidina associada à morfina para analgesia pós-toracotomia.

Método
Um total de 118 pacientes utilizando Analgesia Intravenosa Controlada pelo Paciente (AICP) pós-toracotomia em nosso hospital de Março de 2016 a Julho de 2018 foram selecionados aleatoriamente e divididos em dois grupos: o Grupo Gombinado [COM, 57 pacientes que receberam dexmedetomidina (1,0 μg.kg-1 de peso corpóreo) associada à morfina (0,48 mg.kg-1 de peso corpóreo)] e o Grupo Morfina [MOR, 61 pacientes, que receberam somente morfina (0,48 mg.kg-1)]. Os valores dos subconjuntos de linfócitos (CD3+, CD4+ e CD8+) e das células NK no sangue periférico desses dois grupos foram medidos por citometria de fluxo FACSCalibur em diferentes momentos do estudo [antes da indução anestésica (T0), imediatamente após extubação traqueal (T1), 12 horas após a cirurgia (T2), 24 horas após a cirurgia (T3), 48 horas após a cirurgia (T4), 72 horas após a cirurgia (T5) e 7 dias após a cirurgia (T6)]. As doses de morfina do momento T3 ao T5 e as reações adversas entre os dois grupos também foram registradas e comparadas.

Resultados
O nível de CD3+ e a razão CD4+/CD8+ de T2 a T5, e o nível de CD4+ e as células NK de T3 a T5 do Grupo COM foram significantemente maiores (p < 0,05), quando comparados ao Grupo MOR. A dose de morfina no pós-operatório e a incidência de prurido, náusea e vômito no pós-operatório foram significantemente menores no grupo MOR (p < 0,05).

Conclusões
Dexmedetomidina combinada com morfina para AICP no período pós-toracotomia pode melhorar a função dos linfócitos, reduzir o consumo de morfina e diminuir reações adversas durante a analgesia.

Palavras-chave

Toracotomia;  Dexmedetomidina;  Morfina;  Analgesia;  Linfócitos

References

1 C. Yang, H. Chang, T. Zhang, et al. Pre-emptive epidural analgesia improves post-operative pain and immune function in patients undergoing thoracotomy ANZ J Surg., 85 (2015), pp. 472-477

2 Y. Zhou, J. Huang, Y. Bai, et al. Effects of preemptive analgesia with flurbiprofen ester on lymphocytes and natural killer cells in patients undergoing esophagectomy: A randomized controlled pilot study Thorac Cancer., 8 (2017), pp. 649-654

3 A.B. Carregaro, G.C. Freitas, C. Lopes, et al. Evaluation of analgesic and physiologic effects of epidural morphine administered at a thoracic or lumbar level in dogs undergoing thoracotomy Vet Anaesth Analg., 41 (2014), pp. 205-211

4 J.D. Murphy, J. Paskaradevan, L.L. Eisler, et al. Analgesic efficacy of continuous intravenous magnesium infusion as an adjuvant to morphine for postoperative analgesia: a systematic review and meta-analysis Middle East J Anaesthesiol., 22 (2013), pp. 11-20

5 F.W. Abdallah, R. Brull Facilitatory effects of perineural dexmedetomidine on neuraxial and peripheral nerve block: a systematic review and meta-analysis Br J Anaesth., 110 (2013), pp. 915-925

6 S.J. Bajwa, J. Kaur, A. Singh, et al. Attenuation of pressor response and dose sparing of opioids and anaesthetics with pre-operative dexmedetomidine Indian J Anaesth., 56 (2012), pp. 123-128

7 G. Blaudszun, C. Lysakowski, N. Elia, et al. Effect of perioperative systemic alpha2 agonists on postoperative morphine consumption and pain intensity: systematic review and meta-analysis of randomized controlled trials Anesthesiology., 116 (2012), pp. 1312-1322

8 M.A. Khalil, M.S. Abdel Azeem The impact of dexmedetomidine infusion in sparing morphine consumption in off-pump coronary artery bypass grafting Semin Cardiothorac Vasc Anesth., 17 (2013), pp. 66-71

9 M. Reichert, B. Posentrup, A. Hecker, et al. Thoracotomy versus video-assisted thoracoscopic surgery (VATS) in stage III empyema-an analysis of 217 consecutive patients Surg Endosc., 32 (2018), pp. 2664-2675

10 F. Hetmann, U.E. Kongsgaard, L. Sandvik, et al. Post-thoracotomy pain syndrome and sensory disturbances following thoracotomy at 6- and 12-month follow-ups J Pain Res., 10 (2017), pp. 663-668

11 R. Sharma, R. Gupta, R. Choudhary, et al. Postoperative Analgesia with Intravenous Paracetamol and Dexmedetomidine in Laparoscopic Cholecystectomy Surgeries: A Prospective Randomized Comparative Study Int J Appl Basic Med Res., 7 (2017), pp. 218-222

12 Y. Li, J. Geng, L. Wen, et al. Postoperative analgesia with ropivacaine and dexmedetomidine for ultrasound-guided fascia iliaca compartment block after arthroscopic knee surgery Saudi J Anaesth., 13 (2019), pp. 100-105

13 C. Wang, L. Li, B. Shen, et al. A multicenter randomized double-blind prospective study of the postoperative patient controlled intravenous analgesia effects of dezocine in elderly patients Int J Clin Exp Med, 7 (2014), pp. 530-539

14 C.S. Dong, J. Zhang, Q. Lu, et al. Effect of Dexmedetomidine combined with sufentanil for post- thoracotomy intravenous analgesia: a randomized, controlled clinical study BMC Anesthesiol., 17 (2017), p. 33

15 Z.K. Bengisun, P. Ekmekci, B. Akan, et al. The effect of adding dexmedetomidine to levobupivacaine for interscalene block for postoperative pain management after arthroscopic shoulder surgery Clin J Pain., 30 (2014), pp. 1057-1061

16 Y. Shehabi, P. Grant, H. Wolfenden, et al. Prevalence of delirium with dexmedetomidine compared with morphine-based therapy after cardiac surgery: a randomized controlled trial (Dexmedetomidine Compared to Morphine-DEXCOM Study) Anesthesiology., 111 (2009), pp. 1075-1084

17 J.T. Chang, E.J. Wherry, A.W. Goldrath Molecular regulation of effector and memory T cell differentiation Nat Immunol., 15 (2014), pp. 1104-1115

18 N. Fujimoto, K. Kito, T. Yoshida, T. Tanaka Primary cutaneous CD4/CD8-/- TCRalphabeta T-cell lymphoma Acta Derm Venereol., 95 (2015), pp. 106-107

19 I. Melero, A. Rouzaut, G.T. Motz, et al. T-cell and NK-cell infiltration into solid tumors: a key limiting factor for efficacious cancer immunotherapy Cancer Discov., 4 (2014), pp. 522-526

20 T. Mizota, H. Tsujikawa, T. Shoda, et al. Dual modulation of the T-cell receptor-activated signal transduction pathway by morphine in human T lymphocytes J Anesth., 27 (2013), pp. 80-87

21 T.F. Lin, Y.C. Yeh, T.F.S. Lin, et al. Effect of combining dexmedetomidine and morphine for intravenous patient-controlled analgesia Br J Anaesth., 102 (2009), pp. 117-122

22 Q.H. Cai, Y. Tang, S.H. Fan, et al. In vivo effects of dexmedetomidine on immune function and tumor growth in rats with ovarian cancer through inhibiting the p38MAPK/NF-κB signaling pathway Biomed Pharmacother., 95 (2017), pp. 1830-1837

23 X.D. Ma, B.P. Li, D.L. Wang, et al. Postoperative benefits of dexmedetomidine combined with flurbiprofen axetil after thyroid surgery Exp Ther Med., 14 (2017), pp. 2148-2152

24 W. Dong, M.H. Chen, Y.H. Yang, et al. The effect of dexmedetomidine on expressions of inflammatory factors in patients with radical resection of gastric cancer Eur Rev Med Pharmacol Sci., 21 (2017), pp. 3510-3515
 

5ec6704f0e8825e350ba8f90 rba Articles
Links & Downloads

Rev. Bras. Anestesiol.

Share this page
Page Sections