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Korean Journal of Anesthesiology 2001;41(3):302-310.
DOI: https://doi.org/10.4097/kjae.2001.41.3.302   
Comparative Study of Immunologic Parameters between Spinal and Epidural Anesthesia for a Cesarean Section.
Myung Hee Kim, Duck Hwan Choi, Yeong Lan Kang
Department of Anesthesiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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.
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.
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.
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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