The effect of different anaesthetic techniques on the immune response: review of the literature
Miroslav Župčić, Sandra Graf Župčić, Tatjana Šimurina, Viktor Đuzel, Igor Grubješić, Dinko Tonković, Livija Šakić, Ivana Šutić, Višnja Ivančan, Stjepan Barišin
The immune system comprises both specific and non-specific immunity. The immune response during the perioperative period is modulated by tissue trauma, fear/anxiety, medication, hypothermia, pain, transfusion of blood products, glycaemia regulation, infection and increased stress. Anaesthesia can influence the stress response by central modulation (general anaesthesia), afferent blockade (regional anaesthesia), or by interaction with the endocrine system. The choice of anaesthetic technique seems to have an influence on cancer cells and their possible dissemination. The aims of this review article are to review the effects of regional anaesthesia in comparison to general anaesthesia (intravenous and inhalational) on the immune response to surgical stress, malignant disease progression and postoperative organ function. It is known that general anaesthesia can suppress cellular and humoral immunity by acting on immune-competent cells, gene expression and secretion of inflammatory mediators. Opioids and/or their mode of administration show a different effect on the immune system: immune suppression, immune stimulation or both. In contrast, local anaesthetics are efficient in treating acute and chronic inflammation because they deactivate inflammatory processes on different levels, including the monocyte-macrophage system, decrease of oxygen metabolites and free radical formation, histamine liberation, release of interleukin (IL-1α) and leukotriens. To minimise or avoid immune reactions, the use of local and regional anaesthesia is recommended, as it is superior to other analgesic methods and also reduces postoperative blood loss. Because of these significant advantages, today the use of regional anaesthesia is widespread in oncological surgery.