The effect of combination of general anaesthesia and thoracal epidural analgesia on cytokine response in laparoscopic cholecystectomy

Postoperative pain is the most common problem but is not often in laparoscopic cholecystectomy. Anaesthesia, surgery performing and pain are stressful and cause different reactions in neuro-immuno-endocrine systems. Many factors such as pharmacological effect of used drugs and kind and deep of anaesthesia can affect to these reactions. In this study, we looked into the effect of combination of general anaesthesia and thoracal epidural anaesthesia on cytokine reaction in laparoscopic cholecystectomy.Sixty adult patients with elective laparoscopic cholecystectomy were divided to 4 groups and epidural catheters were implanted at the T9-10 levels before induction. Bupivacaine and fentanyl to the group B, levobupivacaine and fentanyl to the group L, saline and fentanyl to the group F and saline to the group S were infused via epidural catheter before surgical incision.There were no differences among the demographic features and heart rate, mean arterial pressure and peripheral oxygen saturation values of groups. Group L had lower visual analogue scale (VAS) value than the postoperative other groups. Group B had lower VAS value as well, but this value was higher than the Group L. As for group F, VAS values were lower at 30min, 1 and 2 hours compared to Group S. IL-6, IL-8 and IL-10 levels started to increase at 2 hour and returned basal level at 24 hour. Interleukin levels were increased in epidural saline administered group compared to the other groups.In conclusion, the performing of general anaesthesia together with the thoracal epidural anaesthesia provided pain control and hemodinamic stabilisation more efficiently at the first 24 hours in intraoperative and postoperative period by suppressing stress reaction. However we determined that this effect was more obvious with the local anaesthetic and opiod combination.