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Effects of Postoperative Pain Management on Immune Function After Laparoscopic Resection of Colorectal Cancer:A Randomized Study

 So Yeon Kim  ;  Nam Kyu Kim  ;  Seung Hyuk Baik  ;  Byung Soh Min  ;  Hyuk Hur  ;  Jinae Lee  ;  Hyun-young Noh  ;  Jong Ho Lee  ;  Bon-Neyo Koo 
 MEDICINE, Vol.95(19) : 3602, 2016 
Journal Title
Issue Date
Administration, Intravenous ; Aged ; Amides/administration & dosage ; Analgesia, Patient-Controlled/methods ; Analgesics, Opioid/pharmacology* ; Anesthetics, Local/administration & dosage ; Colectomy/adverse effects ; Colectomy/methods ; Colorectal Neoplasms/pathology ; Colorectal Neoplasms/surgery* ; Cytotoxicity, Immunologic/drug effects* ; Drug Therapy, Combination ; Female ; Fentanyl/administration & dosage ; Humans ; Killer Cells, Natural/immunology ; Laparoscopy/adverse effects* ; Male ; Middle Aged ; Neoplasm Recurrence, Local/etiology ; Pain Management/methods ; Pain, Postoperative/drug therapy* ; Postoperative Period ; Tramadol/administration & dosage
There has been a rising interest in the possible association between perioperative opioid use and postoperative outcomes in cancer patients. Continuous surgical wound infiltration with local anesthetics is a nonopioid analgesic technique that can be used as a postoperative pain management alternative to opioid-based intravenous patient-controlled analgesia (IV PCA). The aim of this study was to compare the effects of an opioid-based analgesic regimen versus a local anesthetic wound infiltration-based analgesic regimen on immune modulation and short-term cancer recurrence or metastasis in patients undergoing laparoscopic resection of colorectal cancer.Sixty patients undergoing laparoscopic resection of colorectal cancer were randomly assigned to either the opioid group or the ON-Q group. For postoperative analgesia during the first 48 hours, the opioid group (n = 30) received fentanyl via IV PCA, whereas the ON-Q group (n = 30) received continuous wound infiltration of 0.5% ropivacaine with an ON-Q pump and tramadol via IV PCA. Pethidine for the opioid group and ketorolac or propacetamol for the ON-Q group were used as rescue analgesics. Anesthesia was induced and maintained with propofol and remifentanil. The primary outcome was postoperative immune function assessed by natural killer cell cytotoxicity (NKCC) and interleukin-2. Secondary outcomes were postoperative complications, cancer recurrence, or metastasis within 1 year after surgery, and postoperative inflammatory responses measured by white blood cell count, neutrophil percentage, and C-reactive protein. Immune function and inflammatory responses were measured before surgery and 24 and 48 hours after surgery.Fifty-nine patients completed the study. In the circumstance of similar pain control efficacy between the opioid group and the ON-Q group, postoperative NKCC and interleukin-2 levels did not differ between the 2 groups. The incidence of postoperative complications and recurrence or metastasis within 1 year after surgery was comparable between the groups. Postoperative inflammatory responses were also similar between the groups.When compared with ropivacaine wound infiltration-based analgesia, fentanyl-based analgesia did not further decrease NKCC or affect short-term cancer recurrence or metastasis. Thus, a fentanyl-based analgesic regimen and a ropivacaine wound infiltration-based analgesic regimen can both be used for postoperative pain management in laparoscopic resection of colorectal cancer.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
Koo, Bon-Nyeo(구본녀) ORCID logo https://orcid.org/0000-0002-3189-1673
Kim, Nam Kyu(김남규) ORCID logo https://orcid.org/0000-0003-0639-5632
Kim, So Yeon(김소연) ORCID logo https://orcid.org/0000-0001-5352-157X
Noh, Hyun young(노현영)
Min, Byung Soh(민병소) ORCID logo https://orcid.org/0000-0003-0180-8565
Baik, Seung Hyuk(백승혁) ORCID logo https://orcid.org/0000-0003-4183-2332
Lee, Jinae(이진애)
Hur, Hyuk(허혁) ORCID logo https://orcid.org/0000-0002-9864-7229
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