THE INFLUENCE OF ADJUVANTS ON THE EXPRESSION OF PRO-INFLAMMATORY CYTOKINES DURING SPINAL ANESTHESIA

Abstract

Objective. To investigate the influence of adjuvants (fentanyl and dexmedetomidine) on TNF-α and IL-6 expression during spinal anesthesia based on bupivacaine. Materials and Methods. A total of 150 patients with an average age of 41.3±8.2 years undergoing endoscopic biportal discectomy were examined. Patients were divided into groups: Group 1 received intrathecally 2.5 ml hyperbaric bupivacaine; Group 2 received intrathecally 2.5 ml hyperbaric bupivacaine and 25 μg fentanyl; Group 3 received intrathecally 2.5 ml hyperbaric bupivacaine and 5 μg dexmedetomidine. Peripheral venous blood was collected 1 hour before surgery, at 12 and 24 hours postoperatively, to measure TNF-α and IL-6 levels through solid-phase enzyme-linked immunosorbent assay. Results. The expression of pro-inflammatory cytokines (tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6)) may play a crucial role in modulating postoperative inflammatory reactions. However, contemporary scientific literature presents conflicting data on the influence of anesthetics on cytokine release. Groups 1 and 2 showed a significant increase in TNF-α levels at all observation stages. In Group 3, a significant elevation in TNF-α was observed only 12 hours postoperatively, with no statistically significant difference in the subsequent 24 hours. Inter-group analysis of TNF-α dynamics revealed the smallest increase in Group 3, while Group 1 had significantly higher values compared to Group 3 and Group 2. In all study groups, there was a progressive, statistically significant increase in IL-6 levels within 24 hours postoperatively. However, Group 1 exhibited consistently higher values, with statistically significant differences compared to Group 2 and Group 3. In Groups 2 and 3, statistically significant inter-group differences in IL-6 were noted 12 hours postoperatively, but there was no statistical significance in IL-6 dynamics 24 hours postoperatively. Conclusion. Intrathecal use of bupivacaine with dexmedetomidine had a lesser impact on postoperative TNF-α and IL-6 expression during endoscopic biportal discectomy.