Preoperative pentoxyphylline infusion attenuates surgical immune response and alleviates postoperative pain in a dose-dependent fashion during surgical intensive care stay after panhysterectomy

ABSTRACT

To evaluate the effect of preoperative administration of Pentoxyphylline [PTX] on immune response to surgery and postoperative [PO] pain after panhystrectomy. Forty-five female patients were allocated in 3 equal groups and received intravenous infusion of 100 ml of plain 0.9% NaCI as placebo [control group] or containing 5 or 10 mg/kg PTX, [groups PTX-5 and PTX-10, respectively]. Infusion was given before induction of anesthesia with slow rate for 30 minutes. Duration of PO analgesia, total dose of PO morphine rescue analgesia and visual analogue scale [VAS] scores were determined for 24 hours PO. Serum levels of interleukin [IL]-10, IL-6 and tumor necrosis factor [TNF]-cc were ELISA estimated preoperatively and at 6, 12 and 24 hours postoperatively during and after their surgical intensive care unit [SICU] stay. Mean total VAS pain scores were significantly lower with significantly longer PO duration of analgesia in PTX-10 compared to controls and to PTX-5 group with non-significant difference between PTX-5 and control groups. Total dose of rescue analgesia was significantly lower in PTX-10 group compared to control group and non-significantly compared to PTX-5 group. Both PTX groups showed significantly lower serum levels of TNF-a and IL-6 and significantly higher serum levels of IL-10 compared to control group with significantly lower serum levels of TNF-a and IL-6 and significantly higher serum levels of IL-10 with PTX-10 compared to PTX-5. The effects of PTX on serum IL-6 levels and IL-10 levels were significantly less at 24-hr samples compared to 12-hr samples. Control group showed significantly higher TNF-alpha and IL-6 and significantly lower IL-10 levels at 24-hr compared to levels 12-hr postoperatively. Preoperative PTX infusion modulates the release of nociceptive cytokines with subsequent reduction of PO pain scores and analgesic consumption in a dose dependant fashion