Effect of thoracic epidural block on infection induced inflammatory response: A randomized controlled trial

• Published in: Journal of critical care 2017-04, Vol.38, p.6-12
• Main Authors: Tyagi, Asha, Bansal, Anuradha, Das, Shukla, Sethi, Ashok Kumar, Kakkar, Aanchal
• Format: Article
• Language: English
• Subjects: Abdomen; Adult; Aged; Anesthesia; Anesthesia, Epidural - adverse effects; C-Reactive Protein - metabolism; Calcitonin - blood; Catheters; Critical Care; Cytokines; Double-Blind Method; Female; Fluids; Humans; Infections; Inflammation; Interleukin; Interleukin-10 - blood; Interleukin-6 - blood; Male; Middle Aged; Mortality; Organ Dysfunction Scores; Perforation peritonitis; Postoperative Complications - blood; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Procalcitonin; Sepsis; Sepsis - blood; Sepsis - etiology; Sepsis - prevention & control; Thoracic epidural block; Thoracic Vertebrae - innervation; Treatment Outcome; Ventilation; Young Adult
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2016.10.006

Abstract Purpose Epidural block decreases inflammation and oxidative stress in experimental models of sepsis as well as following 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 (CRP); and postoperative SOFA scores. Material and Methods Sixty adult patients undergoing emergency abdominal laparotomy without any contra-indication to TEB were randomized to receive general anaesthesia 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 pro-inflammatory IL-6; along with appreciably lower procalcitonin levels, decreased incidence of raised CRP 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 TEB showed a trend towards better preservation of anti-inflammatory response and clinical recovery that however failed to achieve statistical significance (P > .05).