Abstract PR367

Abstract

Background & Objectives: The aim of this work is a comparative study of the influence of continuous spinal anesthesia, continuous spinal-epidural anesthesia, and combined general one on patient’s cell-mediated and humoral immunity in THR. Materials & Methods: All the patients enrolled into the study were subdivided intothe groups according to the gender (82.1% women and 17.9% men). Among all the patients underwent THR, equal number (20 in each subgroup) have been subjected to SEA, CSA, and GA. Post-operative analgesia was accompanied by a weak motor block from 1 to 2 scores according to the Bromage Scale. The blood sampling was performed twice: at 24 hours before the operation, and at 72 hours after the operation. The immune system study included assessment of cell-mediated and humoral immune response before and after surgical interventions. Immune cells (total lymphocyte counts, CD3+, CD4+, CD8 lymphocytes) and humoral immunity (IgA, IgG, IgM) have been analyzed. Results: GA was characterized by a weak immune-protective effect which was manifested by inhibition of Ig M, G, A production. Application of CSA was accompanied by a lower tension of regulatory systems, and this promoted savings of protective body resources as well as development of advantageous adaptation strategies. Using SEA resulted in more pronounced stress-protective effect. In the postoperative period, significant elevation of Th cells relative number was observed (15% out of T-cells in SEA), thus suggesting induction of adaptive immunity. Total number of T-cells remainedat normal levels in the postoperative period, however, most of the patients in the GA-subgroup were characterized by greater T-cell immune inhibition (6.5%). The variability in Ts-cells number before and after the operation was negligible and did not depend on anesthesia methods. In the postoperative period, relative number of B-cells elevated up to 46% in CSA, 30% in SEA, and 49% in GA. Immune regulatory index elevated but within the normal limits in the postoperative period in all the groups observed (mainly for SEA), thus evidencing appearance of adequate immune response caused by operative stress. However. Index of phagocytosis decreased (mainly for SEA) but within the normal limits, probably, due to slight suppression of immune reactivity. Conclusion: GA is characterized by dramatic suppression of stress protecting reception and slight stimulation of anti-stress protection of immune cells. Application of CSA is accompanied by less activation of regulatory systems, thereby providing development of non-harmful adaptation strategy and preservation of protective resources. Combined SEA does not suppress humoral immunity, but affects functional activity of phagocytizing neutrophiles. Disclosure of Interest: None declared