Preoperative clonidine or levobupivacaine - effect on systemic inflammatory stress response

Peršec, Jasminka and Peršec, Zoran and Buković, Damir and Merc, Vlasta and Pavelić, Jasminka and Župić, Tomislav (2009) Preoperative clonidine or levobupivacaine - effect on systemic inflammatory stress response. Collegium antropologicum, 33 (2). pp. 573-577. ISSN 0350-6134

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Abstract

With perioperative pain control it is possible to supervise immune system, release of inflammation mediators, and influence on treatment outcome. Use of analgetics before the pain stimulus (preventive analgesia) obstruct development of neuroplastic changes in central nervous system, and reduces pain. Investigation hypothesis was that preoperative epidural clonidine is more efficient in blockade of systemic inflammatory stress response comparing to levobupivacaine. Patients were allocated to three groups, according to preoperative epidural use of clonidine, levobupivacaine or saline (control group). Before operation, 1 h after the beginning, 1 h, 6 h, 12 h and 24 h after the operation following parameters were analyzed: interleukine-6, C-reactive protein and leukocyte count. There were no significant differences between groups in age, gender, body mass index and operation time. In preoperative clonidine group, we found significant reduction in interleukine-6 levels throughout investigation time, compared to preoperative levobupivacaine group and control group. Also, C-reactive protein was significantly lower at the end of investigation, compared to other two groups. Leukocyte count was lower, and within the normal range in all investigation times only in preoperative clonidine group. We demonstrated significant difference that support importance of clonidine central effect on pain pathways and systemic inflammatory blockade.

Abstract in Croatian

PRIJEOPERACIJSKA PRIMJENA KLONIDINA ILI LEVOBUPIVAKAINA – UČINAK NA SUSTAVNI UPALNI ODGOVOR ORGANIZMA ----- Potpunom kontrolom perioperacijske boli možemo nadzirati odgovor imunosnog sustava i oslobađanje medijatora upale, čime izravno utječemo na ishod liječenja. Primjena analgetika prije nastanka bolnog podražaja (preventivna analgezija) sprječava razvoj neuroplastičnih promjena u sredi{njem živčanom sustavu, te može smanjiti razinu boli. Hipoteza istraživanja je da prijeoperacijska epiduralna primjena klonidina značajno učinkovitije blokira bol i sustavni upalni odgovor organizma u odnosu na levobupivakain. Bolesnici su razvrstani u tri skupine, obzirom na prijeoperacijsku epiduralnu primjenu klonidina, levobupivakaina ili fiziolo{ke otopine (kontrolna skupina). Prije operacije, 1 h nakon početka operacije, te 1 h, 6 h, 12 h i 24 h nakon operacije analizirani su parametri: interleukin-6, C-reaktivni protein i leukociti. Između ispitivanih skupina nije bilo statistički značajne razlike u dobi, spolu, tjelesnoj masi i trajanju operacije. U skupini s klonidinom prije operacije dokazane su statistički značajno najniže vrijednosti interleukina-6 tijekom cijelog vremena ispitivanja, u usporedbi s skupinom s levobupivakainom prije operacije i kontrolnom skupinom ispitanika. Dokazane su značajno najniže vrijednosti C-reaktivnog proteina na kraju ispitivanja, u usporedbi s druge dvije skupine ispitanika. Vrijednosti leukocita su tijekom cijelog vremena ispitivanja značajno najniže i unutar normalnih granica jedino u skupini s klonidinom prije operacije. Istraživanjem su dokazane statistički značajne razlike, koje potvrđuju važnost centralnog učinka klonidina na puteve boli i blokadu upalnog odgovora organizma.

Item Type: Article
MeSH: Adrenergic alpha-Agonists/therapeutic use ; Analgesia, Epidural ; Anesthetics, Local/therapeutic use ; Biological ; Markers ; Bupivacaine/analogs & derivatives ; Bupivacaine/therapeutic use ; Clonidine/therapeutic use ; Female ; Humans ; Inflammation/drug therapy ; Inflammation/immunology ; Male ; Neuroimmunomodulation/drug effects ; Pain, Postoperative/drug therapy ; Pain, Postoperative/immunology ; Preoperative Care
Departments: Katedra za ginekologiju i opstetriciju
Depositing User: Marijan Šember
Status: Published
Creators:
CreatorsEmail
Peršec, JasminkaUNSPECIFIED
Peršec, ZoranUNSPECIFIED
Buković, DamirUNSPECIFIED
Merc, VlastaUNSPECIFIED
Pavelić, JasminkaUNSPECIFIED
Župić, TomislavUNSPECIFIED
Date: June 2009
Date Deposited: 23 Sep 2009
Last Modified: 17 Jan 2012 16:13
Subjects: /
Related URLs:
    URI: http://medlib.mef.hr/id/eprint/634

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