| Comparative Study of Immunologic Parameters between Spinal and Epidural Anesthesia for a Cesarean Section. |
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Myung Hee Kim, Duck Hwan Choi, Yeong Lan Kang |
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Department of Anesthesiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. |
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| Abstract |
BACKGROUND
Surgical stress and anesthesia can cause postoperative immunosuppression. T helper lymphocytes play a central role in the immune response. Cytokines secreted from T helper type-1 (Th1) and Th2 influence patients' morbidity. The purpose of the current study was to compare the effect of spinal anesthesia with epidural anesthesia on the T helper cell and cytokine secretions following cesarean section.
METHODS
Forty-four patients were randomly divided into two groups. Total lymphocytes, T helper cells, and T helper type-1 and type-2 cytokines, interleukin-2 (IL-2), interferon gamma (IFN-gamma), and IL-4 and IL-10 in the supernatant of CD4 cells stimulated with phytohemagglutinin were identified by using an enzyme-linked immune assay.
Blood samples were obtained before surgery, 1, 3, and 24 h after the start of surgery.
RESULTS
Significant decreases in lymphocytes and CD4 cells at 3 and 24 h after the start of surgery were seen in epidural anesthesia. The Th1 response, IFN-gamma and IL-2 secretions were detected in 9 patients, in the spinal group, and 9 and 14 patients in the epidural group, respectively.
There were no differences in the Th1 responses between the groups as well as within the groups. Th2 cytokine, IL-10 response in the higher concentration group receiving spinal anesthesia decreased significantly over the three time points studied, but decreased only at 24 h in the epidural group.
CONCLUSIONS
Our results show a possible different immune response profile between the spinal and epidural group: a decreased CD4 level in the epidural group and decreased IL-10 levels in the spinal group according to the time period after surgery. |
| Key Words:
epidural; spinal; T helper cell; cytokines; cesarian section |
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