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Immune response to surgical stress in spinal anaesthesia

Background and Aims: Surgical stress and anaesthesia cause immunosuppression that can predispose patients to postoperative infections and other complications. Anaesthesia may indirectly affect the immune system of surgical patients by modulating neurohormonal stress response. The aim of the study is to establish whether the examined cytokines either individually or in certain correlations may characterise regional (spinal) anaesthesia. Patients and Methods: Nine (9) patients with American Society of Anaesthesiologist status I or II who were scheduled for TURP (transurethral resection of the prostate) were anaesthetised in spinal anaesthesia. .Peripheral venous blood samples were collected 2 hours before surgery, on the first, third and fifth postoperative days. We measured pro-inflammatory cytokines (IL-1a ;I L-1b; TNF-a; IL-6; IL-8; MCP-1; VEGF; EGF), anti-inflammatory cytokines (IL-4; IL-10), and cytokines which are secreted by Th 1 helper lymphocytes (IL-2; IFN-g) in order to establish differences in patients before and after surgery. Results: Serum concentration of pro-inflammatory cytokines (IL-1a; IL-1b; TNF-a;IL-8; MCP-1; VEGF; EGF), anti-inflammatory cytokines (IL-4; IL-10), and cytokines which are secreted by Th 1 helper lymphocytes (IL-2; IFN-g) show no statistically different values before and after surgery. Only serum concentration of IL-6 was significantly (P< 0.05) increased on the first postoperative day and than decreased on the third postoperative day. Discussion and Conclusion: Regional techniques, such as epidural or spinal anaesthesia, with an afferent neural block by local anaesthetics profoundly inhibit hormonal and metabolic stress response. Surgery – related postoperative release of the proinflammatory cytokine IL-6 was increased in patients after spinal anaesthesia with no increased levels of the typical Th1 cytokine IFN-g and no increase of cytokines such as IL-10 and IL-4, which are associated with T-helper type 2 (Th2)-like immune response. Spinal anaesthesia results in less immunosuppression, i.e. maintains the number of Th1 cells, thus stimulating the cell immunity.