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Effect of Preperitoneal Versus Epidural Analgesia on Postoperative Inflammatory Response and Pain Following Radical Cystectomy

A Prospective, Randomized Trial

Othman, Ahmed H., MD*; Ahmed, Doaa G., MD*; Abd El-Rahman, Ahmad M., MD*; El Sherif, Fatma A., MD*; Mansour, Samar, MD; Aboeleuon, Ebrahim, MD

doi: 10.1097/AJP.0000000000000679
Original Articles

Objectives: Continuous wound infiltration of local anesthetics has been proposed as an alternative to epidural analgesia during abdominal surgery. Cytokines have a major role in inflammatory changes caused by surgery. This study aimed to compare the effects of continuous preperitoneal versus epidural analgesia on inflammatory cytokines postoperatively.

Materials and Methods: Forty patients scheduled for radical cystectomy were included in this observer-blinded, randomized trial; patients were randomly assigned into 2 groups to receive; continuous preperitoneal wound infiltration (PPB) or epidural analgesia (EDB). Serum levels of interleukins (IL1β, IL6, IL10, and tumor necrosis factor α) were measured at baseline (before induction of anesthesia), preinfusion (before the start of local anesthetic infusion), 6 and 24 hours postoperatively. Visual Analog Scale at rest/movement (VAS-R/M), time to the first request of analgesia, total morphine consumption, sedation score, hemodynamics, and side effects were observed 24 hours postoperatively.

Results: There was a significant reduction in IL6, IL and increase in IL10 in PPB compared with EDB at 6 and 24 hours postoperatively and compared with preinfusion levels (P≤0.001). In EDB, a significant increase in IL, IL10, and tumor necrosis factor α at 6 hours compared with preinfusion levels (P≤0.002). VAS-R/M was significantly decreased at 2, 4, 6, 8, and 12 hours in EDB compared with PPB (P≤0.014), with no significant difference in the mean time to the first request of analgesia and total morphine consumption between the 2 groups.

Conclusion: Continuous preperitoneal analgesia better attenuated postoperative inflammatory response and provided a comparable overall analgesia to that with continuous epidural analgesia following radical cystectomy.

Departments of *Anesthesia, ICU, and Pain Relief

Clinical Pathology

Surgical Oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt

The authors declare no conflict of interest.

Reprints: Ahmad M. Abd El-Rahman, MD, Department of Anesthesia, ICU, and Pain Management, South Egypt Cancer Institute, Assiut University, El-Methaqe Street, Mansheit El-Omara, Assiut 171516, Egypt (e-mail:

Received June 9, 2018

Received in revised form November 19, 2018

Accepted November 29, 2018

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