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Comparison Between the Effects of Intravenous Morphine, Tramadol, and Ketorolac on Stress and Immune Responses in Patients Undergoing Modified Radical Mastectomy

Bakr, Mohamed A.-E.-M. MD; Amr, Samy A.-E. R. MD; Mohamed, Sahar A. MD; Hamed, Hosny B. MD; Abd EL-Rahman, Ahmad M. MD; Mostafa, Mohamed A. M. MD; El Sherif, Fatma A. MD

doi: 10.1097/AJP.0000000000000338
Original Articles
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Objectives: Analgesics had been suspected of impairing various immune functions either directly or indirectly. Our primary objective was to compare the effects of intravenous (IV) morphine, tramadol, and ketorolac on stress and immune responses in patients who underwent modified radical mastectomy.

Patients: Sixty patients randomly assigned to receive IV morphine 5 mg (group M, n=20), tramadol 100 mg (group T, n=20), or ketorolac 60 mg (group K, n=20) at the end of surgery.

Methods: Serum cortisol, prolactin were measured immediately, 40 minutes, and 24 hours postoperatively. Expressions of peripheral T lymphocytes (CD3+, CD3+CD4+, CD3+CD8+) and natural killer cells (CD3+, CD56+) were measured as percentages of total lymphocytes by flow cytometry immediately, 90 minutes, and 24 hours postoperatively.

Results: After 40 minutes, cortisol level increased but prolactin decreased significantly (P=0.001), then both decreased after 24 hours (P=0.001) compared with baseline within the 3 groups. CD3, CD4, CD8, and CD56 significantly decreased at 90 minutes and 24 hours (P≤0.033) compared with baseline in the 3 groups. CD4, CD8, and CD56 significantly decreased in group M, compared with group T and K (P≤0.016) and CD3, CD8, and CD56 in group T compared with group K at 90 minutes (P≤0.024) postoperatively. After 24 hours, CD4, and CD8 decreased in group M compared with group T (P≤0.048) and CD4 and CD56 in groups M and T compared with group K (P≤0.049).

Conclusions: IV morphine, tramadol, and ketorolac suppressed stress and immune responses. Ketorolac was the least immunosuppressive among the 3 drugs.

*Anesthesia and Intensive Care Department, Faculty of Medicine

Anesthesia, ICU, and Pain Relief Department, South Egypt Cancer Institute

Clinical Pathology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt

The authors declare no conflict of interest.

Reprints: Fatma A. El Sherif, MD, Anesthesia, ICU, and Pain Relief Department, South Egypt Cancer Institute, Assiut University, El-Meathaqe Street, Assiut, Egypt 171516 (e-mail: fatma_anesthesia@yahoo.com).

Received June 25, 2015

Received in revised form February 11, 2016

Accepted November 29, 2015

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