Changes in plasma IL-1 beta, TNF-alpha and IL-6 after total hip replacement surgery in general or regional anaesthesia

Different anaesthetic methods influence the neuro-immuno-endocrine biologic responses to surgery and may thus possibly interfere with the postoperativ e course and development of complications. The neuroendocrine system is clo sely related to the cytokine network, In this study, the effects of general anaesthesia (n=6) and regional spinal/epidural anaesthesia (n=6) on the cy tokine response (IL1 beta, TNF alpha, IL-6) to uncemented total hip replace ment surgery were evaluated, The postoperative clinical course was uneventf ul in every case. In both groups, only very low values of plasma IL-beta we re measured perioperatively, whereas plasma IL-6 increased postoperatively with peak value 4 h after surgery. The changes in plasma TNF-a were not sig nificant. No significant differences in plasma TNF-alpha or IL-6 were found between patients operated in general or in regional anaesthesia, This sugg ests minor influence of plasma cytokines on the possible beneficial effects of regional anaesthesia on the clinical course after surgery in low risk p atients. There were slightly higher TNF-alpha and IL-6 levels after the ope ration and significantly lon er cortisol levels during the operation in the regional anaesthesia group compared to the general anaesthesia group, givi ng rise to a significant inverse correlation between peak values of IL-6 an d peak values of cortisol, This supports the theory that after surgery the inhibitory effect of cortisol on monocyte cytokine production overrides adr energic stimulation. (C) 2000 Academic Press.