Effects of multimodal analgesia on perioperative analgesia and immune function in patients undergoing thoracoscopic lobectomy
WU Shufang1, ZHANG Meifeng1, NING Xinyu2
1. Department of Anesthesiology, Shanxi Medical University,Taiyuan 030001, China; 2. Department of Anesthesiology, the Third Medical Center of PLA General Hospital,Beijing 100039,China
Abstract：Objective To investigate the effects of multimodal analgesia on perioperative analgesia and immune function in patients undergoing thoracoscopic lobectomy. Methods Ninety patients with lung resection under thoracoscope (51 males, 39 females, and aged 18 to 65) were randomly and evenly divided into three groups:the control group in which patient-controlled intravenous analgesia(PCIA)was adopted, Preemptive analgesia group that received flurbiprofen axetil +PCIA, and the multimodal analgesia group where flurbiprofen axetil+thoracic paravertebral nerve block (TPVB)+ PCIA was used. The usage of intraoperative propofol, remifentanil dosage and additional dosage of sufentanil were recorded. The VAS scores at postoperative 6, 24, 48 h and the number of times the analgesia pump was pressed within 48 h were calculated. Venous blood samples were collected before anesthesia (T0), at the end of the surgery(T1), and on the morning of one day(T2) and three days (T3) after operation. The levels of T lymphocyte subsets(CD3+ , CD4+ and CD8+ ) and NK cells were measured by flow cytometry, and the ratio of CD4+/CD8+ was calculated.Results Compared with control group, the dosage of remifentanil and sufentanil supplementation in preemptive analgesia group and multimodal analgesia group were significantly decreased (P<0.05); In preemptive analgesia group,the VAS score at 6 h after surgery was significantly decreased (P<0.05), the percentage of NK cells at T1 and the levels of CD3+, CD4+ and CD4+/CD8+ were significantly increased (P<0.05); In multimodal analgesia group, the VAS scores at 6 h and 24 h after surgery were significantly decreased (P<0.05), the analgesia pump was pressed less frequently(P<0.05), the percentage of NK cells and the levels of CD3+, CD4+,CD4+/CD8+ at T1 and T2, and the levels of CD3+ and CD4+ at T3 were increased(P<0.05), and the incidence of postoperative nausea and vomiting group was lower (P<0.05).Conclusions For thoracoscopic lobectomy, multimodal analgesia can enhance postoperative analgesia, reduce perioperative opioid dosage, alleviate immunosuppression, and increase no incidence of postoperative nausea and vomiting. Besides, flurbiprofen ester combined with paravertebral nerve block had can contribute more to perioperative analgesia and immune function.
Hirsch F R, Scagliotti G V, Mulshine J L, et al. Lung cancer: current therapies and new targeted treatments[J]. Lancet, 2017, 389(10066):299-311.
[2]
O'Brien S M, Klampatsa A, Thompson J C, et al. Function of human tumor-infiltrating lymphocytes in early-stage non-small cell lung cancer[J]. Cancer Immunol Res, 2019, 7(6): 896-909.
Plein L M, Rittner H L. Opioids and the immune system - friend or foe[J]. Br J Pharmacol, 2018,175(14):2717-2725.
[5]
Hung M H, Chan K C, Liu Y J, et al. Nonintubated thoracoscopic lobectomy for lung cancer using epidural anesthesia and intercostal blockade: a retrospective cohort study of 238 cases[J]. Medicine (Baltimore), 2015, 94(13):e727.
[6]
Hiller J G, Perry N J, Poulogiannis G, et al. Perioperative events influence cancer recurrence risk after surgery [J]. Nat Rev Clin Oncol, 2018, 15(4):205-218.
[7]
Tucker E M, Thompson J A, Muckler V C. Implementation of a multimodal analgesia protocol among outpatient neurosurgical patients undergoing spine surgery to improve patient outcomes[J]. J Peri Anesthesia Nurs, 2021,36(1):8-13.
[8]
Fabi D W. Multimodal analgesia in the hip fracture patient[J]. J Orthop Trauma, 2016, 30(Suppl 1):S6-S11.
[9]
Majumder A, Fayezizadeh M, Neupane R, et al. Benefits of multimodal enhanced recovery pathway in patients undergoing open ventral hernia repair[J]. J Am Coll Surg, 2016, 222(6): 1106-1115.
Brown E N, Pavone K J, Naranjo M. Multimodal general anesthesia: theory and practice[J]. Anesth Analg, 2018, 127(5):1246-1258.
[13]
Gelman D, Gelmanas A, Urbanaite D, et al. Role of multimodal analgesia in the evolving enhanced recovery after surgery pathways [J]. Medicina (Kaunas), 2018, 54(2): 154-157.
[14]
Pace M M, Sharma B, Anderson-Dam J, et al. Ultrasound-guided thoracic paravertebral blockade: a retrospective study of the incidence of complications[J]. Anesth Analg, 2016, 122(4):1186-1191.
[15]
Sabouri A S, Crawford L, Bick S K, et al. Is a retrolaminar approach to the thoracic paravertebral space possible? A human cadaveric study[J]. Reg Anesth Pain Med, 2018, 43(8):864-868.
[16]
Kim R. Effects of surgery and anesthetic choice on immunosuppression and cancer recurrence[J]. J Transl Med, 2018, 16(1):8.
2021, Vol. 32 
