The Effects of Ketorolac on T Cell Subsets in Patients Undergoing a Gastrectomy

Ahn, Hyun Joo; Kim, Myung Hee

Abstract

BACKGROUND: Perioperative procedures like surgery, anesthesia, pain control etc. induce immunosuppression and this immunosuppression can be the cause of postoperative infection or micrometastasis. PGE2 is the major cytokine related to immunosuppression especially in tissue trauma. NSAIDs blocked the cyclo-oxygenase pathway and then reduced PGE2 production. Therefore, we studied immunologic changes during a gastrectomy, and the effects of ketorolac administration. We used T cell subsets as immunologic indicator.
METHODS
Forty patients scheduled for a gastrectomy due to stomach cancer were randomly allocated to the control group or the ketorolac group. The ketorolac group received 60 mg ketorolac before anesthesia and then 30 mg 6 hours later. Blood sampling was done before anesthesia, 2 hours and 24 hours after anesthesia. T cell subsets were studied by a monoclonal antibody technique. We also observed postoperative demerol consumption, side effects, infection, and discharge date. A Student's t-test, Mann- Whitney Rank Sum Test, and Chi-square were used for between groups comparisons, and a repeated measured ANOVA and then multiple comparison by the Tukey or Dunnett test for within-group comparison.
RESULTS
T4 was decreased to 89.3%, 81% at 2 hours, and 24 hours in the control group but increased to 128.4%, 104.6% in the ketorolac group. T8 was not different between or within-groups. The T4/T8 ratio was decreased to 83.5%, 84.9% at 2 hours, and 24 hours in the control group but increased to 117.7%, 107.2% in the ketorolac group. 24 hour demerol consumption was higher in the control group than in the ketorolac group. Duration of infection and hospitalization were prolonged in the control group by 1 and 2 days each.
CONCLUSIONS
Ketorolac increased the T4/T8 ratio and reduced demerol consumption, infection, and hosipitalization. Therefore ketorolac could help reverse immunosuppression during the perioperative period especially in immunocompromised patients.