Comparison of cellular immune function during postoperative analgesia with dezocine versus fentanyl in patients with gynecologic malignant tumors / 中华麻醉学杂志

ABSTRACT

Objective To compare the cellular immune function during postoperative analgesia with dezocine and fentanyl in the patients with gynecologic malignant tumors.Methods Fifty patients scheduled for elective surgery for gynecologic malignant tumors, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ , were equally and randomly divided into either dezocine group (group D) or fentanyl group (group F) using a random number table.Total intravenous anesthesia was used for all the patients, and the intraoperatively administered anesthetics was the same.The patient-controlled intravenous analgesia (PCIA) was used for postoperative analgesia.PCIA solution contained dezocine 0.8 mg/kg and tropisetron 6 mg in 100 ml of normal saline in group D.PCIA solution contained fentanyl 0.01 mg/kg and tropisetron 6 mg in 100 ml of normal saline in group F.The PCA pump was set up to deliver a 1 ml bolus dose with a 15-min lockout interval and background infusion at 2 ml/h after a loading dose of 2 ml in the two groups.Tramadol 100 mg was given intravenously as rescue analgesic to maintain visual analogue scale score ≤ 4.Before surgery (T0), at the end of surgery, and at 24 and 48 h after surgery (T2,3) , venous blood samples were collected for detection of T lymphocyte subsets CD3+, CD4+ , CD8+ and natural killer (NK) cell levels (by flow cytometry).CD4+/CD8+ ratio was calculated.The requirement for rescue analgesics and occurrence of adverse reactions such as nausea, vomiting, hypotension and respiratory expression were recorded after surgery.Results No patients required tramadol as rescue analgesic in either group.Compared with the value at T0, the levels of CD3+ , CD4+ and NK cells and CD4+/CD8+ ratio were significantly decreased at T1,2, and the CD8+level was increased at T1 in group D, and the levels of CD3+ cells at T1,2, CD4+ cells at T1 and NK cells at T1-3 were decreased (P＜0.05) , and no significant change was found in CD8+ cell level and CD4+/CD8+ ratio in group F (P＞0.05).Compared with group F, the levels of CD3+ and NK cell were significantly increased at T3 (P＜0.05) , and no significant change was found in the incidence of adverse reactions after surgery in group D (P＞0.05).Conclusion The inhibitory degree of the cellular immune function is reduced when postoperative analgesia is performed with dezocine as compared with that when fentanyl is used in the patients with gynecologic malignant tumors.