The immunological role of monocytes and their cytokines in patients with breast cancer undergoing paravertebral analgesia

Paravertebral block is a method of regional block used to make pain relief and decrease systemic analgesic requirements for patients undergoing breast cancer surgery. This work aimed to evaluate the effect of paravertebral block on monocyte phenotype and their functions after surgery for cancer breast patients. One hundred patients which the American Society of Anesthesia (ASA) I–III planned for breast cancer surgery were allocated into two groups. Group A (n = 50) received general anesthesia in a standard technique. Group B (n = 50) received paravertebral block T2–T6 20 ml plain bupivacaine 0.5 % plus 10 ml 2 % lidocaine prior to induction of general anesthesia. Two samples were collected from all patients preoperatively as a baseline and 24 h after surgery. Flow cytometric monocyte phenotype analysis (CD14, HLA-DR, and CD86) was performed. In addition, tumor necrosis factor alpha (TNF-α), monocyte inhibitory factor (MIF), and macrophage chemoattractant protein (MCP-1) were measured in both groups. There were no significant differences between the two groups as regard to age, weight, height, and duration of surgery. One day after surgery, there was significant decrease in all measured markers (CD14, HLA-DR, and CD86) in group A. On the other hand, insignificant decrease in CD 14 and HLA-DR and insignificant increase in CD86 in group B were observed, also 24 h after surgery. As regard to monocyte producing cytokines, significant increase in TNF-α and MIF levels was recorded in both groups after 24 h of surgery; these increases were the same in TNF-α level and more significant in MIF in group A than group B. MCP-1 was decreased insignificantly in group A and significantly in group B. Paravertebral block combined with general anesthesia can significantly reduce monocyte suppression which is an integral part of immunological response following major surgery.