Abstract
The aim of the study was to evaluate the influence of different variants of anesthesia, including low-opioid (LOA) and opioid-free anesthesia (OFA), on the dynamics of the inflammatory response during laparoscopic hysterectomy.
 Materials and methods: 102 patients were randomly allocated into 3 groups: 37 women assigned to receive a standard opioid-based anesthesia (OBA group), 33 women – LOA group and 32 patients – OFA group. In the LOA group, the amount of fentanyl was halved and lidocaine infusion and ketamine were additionally infused during induction. In the OFA group, ketamine, lidocaine and dexmedetomidine were additionally infused instead of fentanyl.
 Results: Conducting a laparoscopic hysterectomy is accompanied by the activation of the inflammatory process and is manifested by an increase in the content of leukocytes and granulocytes, and a decrease in the number of lymphocytes, which is accompanied by an increase in the leukocyte index of intoxication. These changes were most significant in patients undergoing standard anesthesia. The activation of the inflammatory process is confirmed by an increase in the level of pro-inflammatory IL-6 in all groups from 28.8 % to 92.9 %, and it was most pronounced in patients who underwent LOA. In the same group, the greatest increase in the level of anti-inflammatory IL-10 was also noted, the level of which was 115.4 % higher (p=0.036) than in the control group. An increase in the content of the pro-inflammatory cytokine IL-6 in each group and a parallel increase in anti-inflammatory IL-10 in groups 2 and 3, with a simultaneous decrease in it in group 1 led to a significant increase in the IL-6 / IL-10 ratio in the control group. This indicator was significantly higher than in groups 2 and 3 by 42.3 % (p=0.043) and 52.7 % (p=0.041), respectively, while the IL-6 / IL-10 ratio in these groups was not differed from the initial state.
 Conclusion: Laparoscopic hysterectomy is accompanied by activation of the inflammatory process and is manifested by an increase in the content of leukocytes and granulocytes and a decrease in the number of lymphocytes, which is accompanied by an increase in the leukocyte index of intoxication. These changes were most significant in patients undergoing standard anesthesia. The use of LOA and OFA is accompanied by a lower activation of the inflammatory response in laparoscopic hysterectomy than in standard anesthesia, but requires further study
Highlights
Hysterectomy is one of the most common gynecological surgeries [1], and in recent years, preference is given to laparoscopic methods of its implementation
Due to the increase in the number of granulocytes and a decrease in lymphocytes, there was an increase in leukocyte intoxication index (LII) from 87.2 % (p
The analysis showed that the level of antiinflammatory IL-10 changed statistically significantly during the study stages within the groups and depended on the type of anesthesia
Summary
Hysterectomy is one of the most common gynecological surgeries [1], and in recent years, preference is given to laparoscopic methods of its implementation It is considered the standard of surgical treatment in most women with uterine leiomyoma [2]. The advantages of laparoscopic surgery are obvious They are: minimal tissue trauma, rapid rehabilitation, no scars. Despite these obvious advantages of laparoscopic surgery, it is associated with the risk of developing a number of complications in the perioperative period. In accordance with the concept of safety of endosurgical intervention, the meaning of which is low trauma and good tolerability by the patient, the methods of anesthesia and their safety are improved In this regard, long-term gynecological surgeries are increasingly performed using endoscopic surgical treatment techniques [3]
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