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Evidence-based Practice and Quality Improvement

Effect of enhanced recovery after surgery (ERAS) on secretion of pro-inflammatory cytokines and C-reactive protein af ter hysterectomy


Antypin, E.; Uvarov, D.; Antypina, N.; Semenova, T.; Hussain, A.; Kirov, M.

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European Journal of Anaesthesiology (EJA): June 2013 - Volume 30 - Issue - p 13-13
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Background and Goal of Study: Several studies have demonstrated that ERAS protocol implementation may reduce complication rates and enhance functional recovery in abdominal surgery.

The aim of our study was to determine effects of ERAS protocol on inflammatory response after hysterectomy.

Materials and Methods: 48 patients were randomized into two groups: the ERAS group (n = 23) and the control group (CG) with traditional perioperative management (n = 25). In all patients, combined spinal and epidural anesthesia technique was used. Patient-controlled epidural analgesia in the ERAS group and multimodal analgesia with combination of paracetamol, tramadol and ketoprofen in the control group were used postoperatively. We measured plasma concentrations of interleukin-6 (IL-6), interleukin (IL-1β) and C-reactive protein (CRP) preoperatively and at 24 hours and 7 days after surgery. Data were analyzed by Mann-Whitney U test and presented as median (25th-75th percentiles).

Results and Discussion: There were no significant differences between the groups in values of IL-1β and IL-6, which were in a normal range both at baseline and throughout the study. The plasma concentration of CRP in the control group was higher than in the ERAS group at 24 hours: 7.015 mg/l (5.007 -14.960 mg/l) vs. 2,792 mg/l (1,555-3,512 mg/l) (P = 0,007), and at 7 days after surgery: 14.360 mg/l (7.942 - 14.770 mg/l) vs. 2.266 mg/L (0.900 - 5.614) (P< 0.001). Level of CRP in the control group tended to increase during the observation period.

Conclusion(s): In our study, the plasma concentration of IL-6 and IL-1β did not depend on the method of postoperative pain management. Using the ERAS protocol reduced postoperative plasma concentration of CRP. The increased level of CRP in the control group may be related with autoimmune reaction in wound due to delayed mobilization of patients.

© 2013 European Society of Anaesthesiology