Department of Anesthesiology and Pain Medicine, Hyogo Medical University Faculty of Medicine, Nishinomiya, Hyogo, Japan.
Department of Anesthesiology & Reanimatology, Faculty of Medicine Sciences, University of Fukui, Eiheiji-cho, Fukui, Japan.
Medicine (Baltimore). 2023 Sep 1;102(35):e34832. doi: 10.1097/MD.0000000000034832.
A recent study showed that thoracic epidural block (TEB) suppressed the occurrence of major complications after pleurectomy/decortication (P/D) for malignant pleural mesothelioma (MPM) under general anesthesia. To investigate the mechanisms underlying the correlation, both acute inflammatory status and intraoperative nociception were evaluated in the present study. In a single-institutional observational study, consecutive adult patients undergoing P/D were enrolled from March 2019 to April 2022. Perioperative acute inflammatory status was evaluated using differential White blood cell (WBC) counts and serum concentration of C-reactive protein (CRP) both before and after the surgery on postoperative day (POD) 1. The averaged value of nociceptive response index during surgery (mean NR) was obtained to evaluate the level of intraoperative nociception. Multivariable logistic regression analysis was performed to determine the association between perioperative variables and major complications Postoperative major postoperative complication was defined as Clavien-Dindo grades ≥ III. We conducted this study with 97 patients. After logistic regression analysis showed that general anesthesia without TEB was a sole risk factor for major complications, patients were divided into 2 groups: general anesthesia with and without TEB. The incidence of major complications was significantly lower in patients with TEB (33.3%, n = 33) than in those without TEB (64.1%, n = 64, P < .01). Although there was no significant difference in the CRP level between 2 groups, the lymphocyte-to-monocyte ratio (LMR) on POD 1 in patients with TEB was significantly higher than that in patients without TEB (P = .04). The mean NR was significantly lower in patients with TEB than that in those without TEB (P = .02). Both lower mean NR during surgery and higher LMR on POD 1 are likely associated the suppression of major complications due to TEB after P/D under general anesthesia. Decreases in the postoperative acute inflammatory response, caused by the reduction of intraoperative nociception due to TEB, may help suppress major complications after P/D.
一项最近的研究表明，全身麻醉下胸腔硬膜外阻滞（TEB）可抑制恶性胸膜间皮瘤（MPM）患者行胸膜切除术/剥脱术后主要并发症的发生。为了探讨相关性的机制，本研究评估了急性炎症状态和术中痛觉。在一项单机构观察性研究中，连续纳入 2019 年 3 月至 2022 年 4 月行 P/D 的成年患者。通过术前和术后第 1 天（术后第 1 天）的白细胞（WBC）差异计数和血清 C 反应蛋白（CRP）浓度评估围手术期急性炎症状态。获得手术期间平均疼痛反应指数（mean NR），以评估术中疼痛程度。多变量逻辑回归分析用于确定围手术期变量与主要并发症之间的关系。术后主要并发症定义为 Clavien-Dindo 分级≥Ⅲ级。我们对 97 例患者进行了这项研究。逻辑回归分析显示，全身麻醉无 TEB 是主要并发症的唯一危险因素后，将患者分为全身麻醉加 TEB 组和全身麻醉无 TEB 组。TEB 组的主要并发症发生率明显低于无 TEB 组（33.3%，n=33）比无 TEB 组（64.1%，n=64，P<0.01）。两组间 CRP 水平无显著差异，但 TEB 组术后第 1 天的淋巴细胞与单核细胞比值（LMR）明显高于无 TEB 组（P=0.04）。TEB 组的平均 NR 明显低于无 TEB 组（P=0.02）。TEB 组术中平均 NR 较低，术后第 1 天 LMR 较高，可能与全身麻醉下 P/D 后 TEB 抑制主要并发症有关。TEB 降低术中痛觉引起的术后急性炎症反应可能有助于抑制 P/D 后的主要并发症。
