Background: The postoperative period is associated with the increased production of cytokines, which augments the sensitivity to pain. Epidural analgesia might reduce the postoperative stress response and influence the immune function. This study evaluated the effect of patient-controlled epidural analgesia (PCEA) on the cytokine response, compared with patient-controlled intravenous analgesia (PCIA) in patients undergoing a gastrectomy.

METHODS: Twenty-nine patients undergoing a gastrectomy were randomly assigned to one of two postoperative pain management techniques: PCIA (fentanyl 15µ/ml) or PCEA (fentanyl 3µ/ml in 0.1% ropivacaine). The level of postoperative pain was assessed at rest and during coughing using the visual analog scale (VAS). Blood samples were collected before administering anesthesia and 6, 24, and 48 h after surgery. The plasma concentrations of the tumor necrosis factor (TNF)-α interleukin (IL)-1β, IL-6, IL-8, IL-1ra, IL-10, and IL-2 were assessed.

Results: The patients in the PCEA group showed lower VAS pain scores during the 72 h after surgery, compared with the patients in the PCIA group. There was no change in the levels of TNF-αand IL-2 between the two groups at all times examined. In both groups, the levels of IL-1β IL-6, IL-8, IL-1ra, and IL-10 increased after surgery (each group, P

CONCLUSIONS: These results suggest that PCEA has no added influences on the cytokine responses after a gastrectomy.