Asha Tyagi1, Anuradha Bansal2, Shukla Das3, Ashok Kumar Sethi4, Aanchal Kakkar5. 1. Department of Anaesthesiology & Critical Care, University College of Medical Sciences & GTB Hospital, Delhi 110095, India. Electronic address: drashatyagi@gmail.com. 2. Department of Anaesthesiology & Critical Care, University College of Medical Sciences & GTB Hospital, Delhi 110095, India. Electronic address: bansal.a.1988@gmail.com. 3. Department of Microbiology, University College of Medical Sciences & GTB Hospital, Delhi 110095, India. Electronic address: shukladas_123@yahoo.com. 4. Department of Anaesthesiology & Critical Care, University College of Medical Sciences & GTB Hospital, Delhi 110095, India. Electronic address: newdraksethi@gmail.com. 5. Department of Anaesthesiology & Critical Care, University College of Medical Sciences & GTB Hospital, Delhi 110095, India. Electronic address: kakkaraanchal2@gmail.com.
Abstract
PURPOSE: Epidural block decreases inflammation and oxidative stress in experimental models of sepsis as well as after surgery. There is, however, no clinical evidence evaluating its effect on infection-induced inflammatory process. The present trial evaluated the effect of thoracic epidural block (TEB) on systemic inflammatory response in patients with small intestinal perforation peritonitis. Outcome measures included systemic levels of interleukin (IL)-6, IL-10, procalcitonin, and C-reactive protein and postoperative Sepsis-Related Organ Failure Assessment scores. MATERIAL AND METHODS:Sixty adult patients undergoing emergency abdominal laparotomy without any contraindication to TEB were randomized to receive general anesthesia alone or in combination with the TEB, which was continued for 48 hours postoperatively (n = 30 each). RESULTS: Use of TEB was associated with a statistically insignificant trend of preservation of anti-inflammatory response depicted by higher levels of IL-10 and lack of alteration in proinflammatory IL-6, along with appreciably lower procalcitonin levels, decreased incidence of raised C-reactive protein levels, and better postoperative SOFA score (P > .05). It resulted in significantly better postoperative respiratory function and faster return of bowel motility (P < .05). Although the sample size is too small for conclusive statement, none of the patients developed epidural abscess. CONCLUSION:Thoracic epidural block showed a trend toward better preservation of anti-inflammatory response and clinical recovery that, however, failed to achieve statistical significance (P > .05).
RCT Entities:
PURPOSE: Epidural block decreases inflammation and oxidative stress in experimental models of sepsis as well as after surgery. There is, however, no clinical evidence evaluating its effect on infection-induced inflammatory process. The present trial evaluated the effect of thoracic epidural block (TEB) on systemic inflammatory response in patients with small intestinal perforation peritonitis. Outcome measures included systemic levels of interleukin (IL)-6, IL-10, procalcitonin, and C-reactive protein and postoperative Sepsis-Related Organ Failure Assessment scores. MATERIAL AND METHODS: Sixty adult patients undergoing emergency abdominal laparotomy without any contraindication to TEB were randomized to receive general anesthesia alone or in combination with the TEB, which was continued for 48 hours postoperatively (n = 30 each). RESULTS: Use of TEB was associated with a statistically insignificant trend of preservation of anti-inflammatory response depicted by higher levels of IL-10 and lack of alteration in proinflammatory IL-6, along with appreciably lower procalcitonin levels, decreased incidence of raised C-reactive protein levels, and better postoperative SOFA score (P > .05). It resulted in significantly better postoperative respiratory function and faster return of bowel motility (P < .05). Although the sample size is too small for conclusive statement, none of the patients developed epidural abscess. CONCLUSION: Thoracic epidural block showed a trend toward better preservation of anti-inflammatory response and clinical recovery that, however, failed to achieve statistical significance (P > .05).