Neuroimmunomodulation by regional and general anaesthesia

Background and Purpose: This review presents the detailed immunological impact of neural variables, including stress, on specific cellular and molecular events that that take place over the full (time course) duration of autoimmune, inflammatory, allergic and infectious diseases. Materials and Methods: A comprehensive search of literature from major injury (serious traumatic injury and major burns) to major surgical procedures that often lead to severe immunosuppression, which contributes to delayed wound healing, infectious complications and, in some cases, to sepsis, the most common cause of late death after trauma. Results: Strong stimulation of the SNS and theHPA axis correlates with the severity of both cerebral and extracerebral injury and an unfavourable prognosis. The suppressed cellular immunity is associated with diminished production of IFN-γ and IL-12 and increased production of IL-10 – Th2 shift. Disbalance in relations Th1 and Th2 cytokine secreted by the T lymphocytes is considered the main difference between general and regional anaesthesia. Conclusions: Considerable in-vitro data and in-vivo animal studies suggest that three factors associated with cancer surgery impair cellular immunity: the stress response to tissue injury, general anaesthesia and opioid analgesia. Regional analgesia decreases the neuroendocrine stress response to surgical tissue injury, eliminates or reduces the need for general anaesthesia and minimises opioid requirement. Thus cancer recurrence is lower after surgery with regional anaesthesia/analgesia than after surgery with general anaesthesia and opioid analgesia