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CHANGES IN EXPRESSION OF CYTOLITIC MOLECULE PERFORIN IN PERIPHERAL BLOOD LYMPHOCYTES AFTER EPIDURAL ANESTHESIA IN PATIENTS WITH COLORECTAL CARCINOMA

Background and aims: The postoperative changes are induced by neuroendocrine, metabolic and immune alteration which are caused by tissue damage, anesthesia, postoperative pain and psychological stress. In postoperative period suppression of immune response was very often. Postoperative pain contributs to dysfunction of immune response as a result of interaction between central nervous and immune systems. The postoperatively activated hypotalamo-pituitary-adrenocortical and sympatoadrenal axis are important modulators of immune response. Afferent neural blockade by epidural analgesia can decrease neuroendocrine stress response. According to bidirectional communication of immune and nervous system, appropriate postoperative pain management could affect immune response in postoperative period. The aim of this study was to examine alteration of cell mediated immunity and cytolytic molecule perforin in different lymphocyte subpopulation in peripheral blood of patient after resection of colorectal carcinoma when postoperative pain may be reduced by epidural analgesia. Methods: Venous blood samples were taken and peripheral blood leukocytes (PBL) were isolated. Phenotype of lymphocytes and perforin expression were analyzed using intracellular and surface immunofluoresecncy and flow cytometric analysis (FACSCalibur). Statistical analysis was done in computer program Statistica 7.1 (StatSoft, Inc., Tulsa, OK, USA). Graphs and tables were done in computer program Microsoft Excel. Results: The results demonstrated that 20-30% of PBL in all examine group are perforin positive (total perforin is significantly higher than in control group). These results suggest that human perforin is differentially expressed in distinct sub-populations of peripheral blood lymphocytes of patients with colorectal carcinoma, indicating that cytotoxic potentials of lymphatic cells are changed during epidural anesthesia. Conclusions: The postoperative pain management by epidural analgesia in patient after colorectal surgery can diminish pain and therefore affect cell mediated immunity, perforin expression and cytotoxic activity of peripheral blood cells.

colorectal carcinoma; postoperative pain; immune response; epidural analgesia

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