Abstract: The stress of surgery is characterized by an inflammatory response with immune suppression resulting from many factors, including the type of surgery and the kind of anesthesia, linked with the drugs that are used and the underlying disease of the patient. The trauma of surgery triggers a cascade of reactions involving the immune response and nociception. As strong analgesics, opioids provide the analgesic component of general anesthesia with bi-directional effect on the immune system. Opioids influence almost all aspects of the immune response in regards to leukocytes, macrophages, mast cells, lymphocytes, and NK cells. The suppressive effect of opioids on the immune system is limiting their use, especially in patients with impaired immune response, so the possibility of using multimodal anesthesia without opioids, known as opioid-free anesthesia (OFA), is gaining more and more sympathizers. The idea of OFA is to eliminate opioid analgesia in the treatment of acute pain and to replace it with drugs from other groups that are assumed to have a comparable analgesic effect without affecting the immune system. Here, we present a review on the impact of anesthesia, with and without the use of opioids, on the immune response to surgical stress.

Keywords: opioids, opioid-free anesthesia, immune response, surgical stress


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关于免疫反应哪个想法更好？阿片类药物或无阿片类药物的麻醉

摘要：手术压力的特征在于由多种因素引起的炎症反应和免疫抑制，包括与所用药物和患者潜在疾病相关的手术类型和麻醉类型。外科手术的创伤引发了涉及免疫反应和伤害感受的一系列反应。阿片类药物作为强镇痛药，可为全身麻醉的镇痛成分提供对免疫系统的双向作用。阿片类药物影响有关白细胞，巨噬细胞，肥大细胞，淋巴细胞和NK细胞的免疫应答的几乎所有方面。阿片类药物对免疫系统的抑制作用限制了它们的使用，尤其是在免疫反应受损的患者中，因此可以使用无阿片类药物的多峰麻醉，被称为无阿片类药物麻醉（OFA）的麻醉剂越来越多。OFA的想法是消除阿片类药物的镇痛作用，并用其他组别的药物代替，以免产生镇痛作用，而不会影响免疫系统。在这里，我们对麻醉的影响进行回顾，无论是否使用阿片类药物，麻醉对手术压力的免疫反应都是如此。

关键词：阿片类药物，无阿片类药物的麻醉，免疫应答，手术压力