Effects of PCIA with nalbuphine on postoperative cellular immune function in patients undergoing liver cancer resection

Abstract

Objective To evaluate the effects of patient-controlled intravenous analgesia (PCIA) with nalbuphine on postoperative cellular immune function in the patients undergoing liver cancer resection. Methods Eighty hepatoma patients of both sexes, aged 40-64 yr, with body mass index 19-25 kg/m2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, undergoing elective liver cancer resection, were divided into 2 groups (n=40 each) using a random number table method: sufentanil PCIA group (S group) and nalbuphine PCIA group (N group). Transverse abdominal plane block was performed in two groups.In group S, sufentanil 0.1 μg/kg was intravenously injected at 30 min before the end of surgery, PCIA was performed with sufentanil 2 μg/kg plus ondansetron 16 mg (diluted to 100 ml in normal saline) at the end of surgery, and PCA pump was set up with a 1 ml bolus dose, a 10-min lockout interval and background infusion at a rate of 2 ml/h.In group N, nalbuphine 0.1 mg/kg was intravenously injected at 30 min before the end of surgery, PCA was performed with nalbuphine 2 mg/kg plus ondansetron 16 mg (diluted to 100 ml in normal saline) at the end of surgery, and PCIA pump was set up with a 1 ml bolus dose, a 10-min lockout interval and background infusion at a rate of 2 ml/h, maintaining visual analog scale score <4 within 48 h after surgery.Blood samples were collected from the right internal jugular vein on admission to operating room (T1) and 24 and 72 h after surgery (T2, 3) for measurement of levels of T lymphocyte subsets CD3+ , CD4+ and CD8+ , B cells and NK cells.CD4+ /CD8+ ratio was calculated. Results Compared with S group, levels of CD3+ and CD4+ cells at T2 and levels of CD4+ and NK cells at T3 were significantly increased in N group (P<0.05). Compared with the baseline at T1, the levels of CD3+ , CD4+ , NK and B cells at T2 and NK cells at T3 were significantly decreased in two groups, and CD4+ /CD8+ ratio was decreased at T2 in group S (P<0.05). Conclusion PCIA with nabuphine can improve the postoperative cellular immune function in the patients undergoing liver cancer resection. Key words: Nalbuphine; Analgesia, patient-controlled; Immunity, cellular