Impact of post-thoracotomy analgesia with dexmedetomidine and morphine on immunocytes: a randomized clinical trial

Lei, Pengfei; Wang, Jin; Gao, Shan; Du, Bo; Wang, Hao; Li, Weichun; Shi, Fei; Shan, Aijun

doi:10.1016/j.bjane.2020.04.017

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Revista Brasileira de Anestesiologia

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Sumário

Scientific Article • Rev. Bras. Anestesiol. 70 (2) • Mar-Apr 2020 • https://doi.org/10.1016/j.bjane.2020.04.017 copy

Impact of post-thoracotomy analgesia with dexmedetomidine and morphine on immunocytes: a randomized clinical trial

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

This study aimed to investigate the impact of post-thoracotomy analgesia with dexmedetomidine and morphine on immunocytes.

Methods

A total of 118 patients with post-thoracotomy Patient-Controlled Intravenous Analgesia (PCIA) in our hospital from March 2016 to July 2018 were randomly selected and divided into the Composite (COM) Group (57 patients administered with dexmedetomidine [1.0 µg.kg^-1 body weight] and morphine [0.48 mg.kg^-1 body weight]) and the Morphine (MOR) group (61 patients administered with morphine [0.48 mg.kg^-1]). The values of lymphocyte subsets (CD3+, CD4+, and CD8+) and Natural Killer cells in the peripheral blood of these two groups were detected by FACSCalibur flow cytometry at different time points (before anesthesia induction [T0], immediately after tracheal extubation [T1], 12 hours after surgery [T2], 24 hours after surgery [T3], 48 hours after surgery [T4], 72 hours after surgery [T5], and 7 days after surgery [T6]). The doses of morphine at T3 to T5 and the adverse reactions between the two groups were also recorded and compared.

Results

The CD3+ level and the CD4+/CD8+ ratio at T2 to T5 and the CD4+ level and NK cells at T3 to T5 were significantly higher in the COM Group than in the MOR Group (p< 0.05). The postoperative morphine dose and the incidence of postoperative itching, nausea, and vomiting were significantly lower in the COM Group than in the MOR Group (p< 0.05).

Conclusions

Dexmedetomidine combined with morphine for post-thoracotomy PCIA can improve the function of immunocytes, reduce morphine consumption, and reduce the adverse reactions during analgesia induction.

KEYWORDS
Thoracotomy; Dexmedetomidine; Morphine; Analgesia; Immunocytes

Group	n	M/F (n)	Age (years)	Weight (kg)	BMI (kg. m^-2)
COM	57	29/28	52.2 ± 6.9	57.2 ± 3.9	21.7 ± 1.6
MOR	61	27/34	52.9 ± 7.4	57.9 ± 4.5	21.2 ± 1.1

Group	n	T3	T4	T5
COM	57	16.5 ± 6.7^a a p < 0.05.	35.8 ± 9.7^a a p < 0.05.	55.3 ± 8.9^a a p < 0.05.
MOR	61	27.6 ± 9.5	51.9 ± 11.2	73.2 ± 7.6

Index	Group	n	T₀	T₁	T₂	T₃	T₄	T₅	T₆
CD3⁺ (%)	COM	57	63.1 ± 4.5	57.1 ± 3.7^a a p < 0.05; compared with group MOR,	54.9 ± 3.4^a a p < 0.05; compared with group MOR, ^b b p < 0.05.	52.7 ± 2.7^a a p < 0.05; compared with group MOR, ^b b p < 0.05.	57.3 ± 4.1^a a p < 0.05; compared with group MOR, ^b b p < 0.05.	59.7 ± 5.1^a a p < 0.05; compared with group MOR, ^b b p < 0.05.	62.8 ± 4.2
CD3⁺ (%)	MOR	61	62.8 ± 4.7	55.3 ± 4.1^a a p < 0.05; compared with group MOR,	52.6 ± 3.6^a a p < 0.05; compared with group MOR,	49.7 ± 4.3^a a p < 0.05; compared with group MOR,	53.6 ± 3.7^a a p < 0.05; compared with group MOR,	57.5 ± 2.4^a a p < 0.05; compared with group MOR,	62.3 ± 4.5
CD4⁺ (%)	COM	57	36.9 ± 4.5	31.7 ± 1.9^a a p < 0.05; compared with group MOR,	29.5 ± 2.2^a a p < 0.05; compared with group MOR,	28.2 ± 2.9^a a p < 0.05; compared with group MOR, ^b b p < 0.05.	31.5 ± 4.3^a a p < 0.05; compared with group MOR, ^b b p < 0.05.	32.9 ± 5.4^a a p < 0.05; compared with group MOR, ^b b p < 0.05.	35.6 ± 4.0
CD4⁺ (%)	MOR	61	36.5 ± 4.2	31.9 ± 5.7^a a p < 0.05; compared with group MOR,	27.1 ± 2.9^a a p < 0.05; compared with group MOR,	24.8 ± 3.1^a a p < 0.05; compared with group MOR,	27.3 ± 5.2^a a p < 0.05; compared with group MOR,	29.8 ± 3.6^a a p < 0.05; compared with group MOR,	33.5 ± 3.7
CD8⁺ (%)	COM	57	24.3 ± 4.4	23.8 ± 4.5	23.2 ± 4.3	22.9 ± 4.2	23.5 ± 3.9	24.1 ± 4.1	23.9 ± 4.3
CD8⁺ (%)	MOR	61	24.7 ± 4.6	24.3 ± 4.5	24.0 ± 4.2	23.9 ± 4.4	24.1 ± 3.9	23.7 ± 3.7	24.3 ± 4.1
CD4⁺/ CD8⁺	COM	57	1.5 ± 0.3	1.2 ± 0.2^a a p < 0.05; compared with group MOR,	1.2 ± 0.2^a a p < 0.05; compared with group MOR, ^b b p < 0.05.	1.2 ± 0.2^a a p < 0.05; compared with group MOR, ^b b p < 0.05.	1.3 ± 0.2^a a p < 0.05; compared with group MOR, ^b b p < 0.05.	1.4 ± 0.1^a a p < 0.05; compared with group MOR, ^b b p < 0.05.	1.5 ± 0.3
CD4⁺/ CD8⁺	MOR	61	1.5 ± 0.2	1.2 ± 0.3^a a p < 0.05; compared with group MOR,	1.1 ± 0.2^a a p < 0.05; compared with group MOR,	1.1 ± 0.3^a a p < 0.05; compared with group MOR,	1.2 ± 0.1^a a p < 0.05; compared with group MOR,	1.3 ± 0.2^a a p < 0.05; compared with group MOR,	1.4 ± 0.2
NK cells (%)	COM	57	14.4 ± 1.9	12.1 ± 1.2^a a p < 0.05; compared with group MOR,	11.8 ± 1.5^a a p < 0.05; compared with group MOR,	11.4 ± 1.4^a a p < 0.05; compared with group MOR, ^b b p < 0.05.	13.1 ± 1.3^a a p < 0.05; compared with group MOR, ^b b p < 0.05.	13.5 ± 1.6^a a p < 0.05; compared with group MOR, ^b b p < 0.05.	14.2 ± 1.7
NK cells (%)	MOR	61	14.6 ± 2.2	11.9 ± 1.6^a a p < 0.05; compared with group MOR,	11.1 ± 1.2^a a p < 0.05; compared with group MOR,	10.3 ± 1.8^a a p < 0.05; compared with group MOR,	11.6 ± 1.5^a a p < 0.05; compared with group MOR,	12.9 ± 1.4^a a p < 0.05; compared with group MOR,	14.2 ± 2.0

Group	n	Pruritus	Nausea	Vomiting
COM	57	3 (5.3)^a a p < 0.05.	9 (15.8)^a a p < 0.05.	6 (10.5)^a a p < 0.05.
MOR	61	13 (21.3)	23 (37.7)	15 (24.6)

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[1] * Corresponding author. E-mails: cnpengfeilei@163.com (F. Shi), abv236@126.com (A. Shan).