COMPARISON OF C-REACTIVE PROTEIN, CORTISOL AND INTERLEUKIN-6 DYNAMICS AFTER BREAST SURGERY UNDER GENERAL ANESTHESIA, OR GENERAL ANESTHESIA IN COMBINATION WITH PECTORAL BLOCK, OR GENERAL ANESTHESIA IN COMBINATION WITH THORACIC PARAVERTEBRAL BLOCK
Authors: Martsiniv V. V. 
Published: July 2021

Modern anesthesiologic coverage and support has its one of the main goals to decrease a surgical stress response of the patient after surgery. It is very important especially in cancer patients. Breast cancer is the most frequently diagnosed malignancy among women in Ukraine. The thoracic paravertebral block is widely used for analgesia of breast surgery by decades. In recent years, novel miofascial blocks, such of them ultrasound-guided pectoral nerve block type II, have become a very popular anesthesiologic technique in addition to general anesthesia for breast surgeries. A precise impact of these new methods of analgesia on the surgical stress response remains to be discovered.

The goal of the research: to investigate surgical stress-response of the breast cancer surgical patient after Pectoral nerve block, Paravertebral block, or general anesthesia.

Materials and methods. This is single center, prospective study. Ninety-one women after an elective mastectomy or quadrantectomy with axillary nodes dissection were included. Depending on the method of anesthesia, patients were randomly divided into three groups. The General Anesthesia group (GA) — only general anesthesia, PB group — general anesthesia plus pectoral nerve block type II with ropivacaine 0.375% 30 ml and PVB group — general anesthesia plus thoracic paravertebral block with ropivacaine 0.5% 20 ml. All blocks were performed under ultrasound control. The plasma levels of CRP, IL-6 were measured before and 24 hours after surgery. The plasma level of Cortisol was measured before surgery, 0 and 24 hours after. Postoperative pain was evaluated using the Numerical rating scale (NRS) at 0, 1, 2, 6, 12, 18 and 24 hours after surgery.

Results. The initial (preoperative) levels of biomarkers were equal in three investigation groups. Immediate after surgery Cortisol level decreased in PB and PVB groups to 267 (182- 416) nmol/l and 311 (196-378) nmol/l respectively and increased in GA group to 355 (246-483) nmol/l, but without statistically significance (р=0.132). The day after surgery Cortisol’s level was: 340 (253-381) nmol/l; 314 (231-416) nmol/l and 339 (228-398) nmol/l respectively (р=0.678).

The day after surgery C-reactive protein was statistically significant lower in blocks groups. It was achieved in GA group 83.0 (51.3-94.0) mg/l, PB group – 51.9 (36.1-79.5) mg/l, PVB group – 61.7 (25.6-73.9) mg/l (р=0.062).

In a day after surgery the highest level of IL-6 was observed in the GA group, then in the PB and PVB groups: 29.5 (16.9-33.1) pg/ml, 22.2 (11.5-31.6) pg/ml and 16.8 (14.0-19.5) pg/ml respectively (р=0.002).

Statistically significantly lower NRS pain scores were observed in the PB and PVB groups compared with the GA group in 1, 2, 6 and 24 hours after surgery.

Conclusion. Analgesia with both pectoral nerve block or thoracic paravertebral block compared to general anesthesia alone for breast cancer surgery is associated with lower postoperative levels of CRP and IL-6, which suggest about decreasing stress-response to the surgery.