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Epidural Anesthesia with Lidocaine and Dexmedetomidine, Versus Lidocaine Alone on Plasma Levels of IL-6 in Patients with Proximal Femoral Fracture.

Mohammadreza Moshari, Bahman Malek, Adel Ebrahimpour, Maryam Vosoughian, Mastaneh Dahi-Taleghani, Ehsan Ghorbani, Seyed Mohammad Seyed-Alshohadaei




Interleukin-6 plays an important role in inflammatory responses and synthesis of acute hepatic phase proteins and its plasma level changes are used as a reliable prognostic factor for mortality in hospitalized patients. On the other hand, various methods for reducing inflammatory responses, including proper control of pain during and after surgery, and correction of hemodynamic disorders, can be monitored by monitoring of plasma levels of IL-6. Epidural anesthesia is an appropriate method for controlling pain in lower limb surgeries. The aim of this study was to evaluate the effect of adding Dexmedetomidine to lidocaine in the epidural injection for better control of post-surgical inflammatory responses by measuring interleukin-6 plasma levels.

Patients referred to Taleghani Hospital in 1396 who suffered from lower limb fractures and requiring surgery were evaluated. 52 patients in two groups receiving Dexmedetomidine doses of media and controls for the quality of epidural anesthesia and IL-6 index. After obtaining written consent, the Dexmedetomidine treatment group and the normal saline control group were prescribed epidural with lidocaine. Finally, the level of IL-6 before surgery and 6 hours after surgery were evaluated.

According to the results of statistical analysis, the two groups did not show a significant difference in age and level of interleukin prior to the operation. The mean age of patients in this study was 15.84639 ± 53.4038. The sex distribution of the study included 19 women (36.5%) and 33 men (63.5%). According to the U Mann Whitney test, the second injection time and total drug volume had a significant difference between the control and intervention groups and Dexmedetomidine reduced the volume of total drug needed and increase the time interval until the second injection (p <0.001). There was also a significant difference between the two groups in the level of interleukin 6 after 6 hours of operation and this was lower in the Dexmedetomidine group.

keywords: Interleukin-6, Dexmedetomidine, lidocaine, Anesthesia


Interleukin-6, Dexmedetomidine, lidocaine, Anesthesia


Charles B, Strichantz B&GR. Local anesthetics: In Miller, RD, editor. Anesthesia. Vol 1, 5th ed.Philadelphia: Churchill Livingstone; 2000, P. 491-517.

Turkan H, Baykal B, Ozisik T. Axillary brachial plexus blockade: an evaluation of three techniques. Mil Med. 2002;167(9):723-5.

Bergendahl H, Lönnqvist PA, Eksborg S. Clonidine: an alternative to benzodiazepines for premedication in children. Current opinion in anesthesiology. 2005;18(6):608-13.

Hollmann MW, Durieux ME. Local anesthetics and the inflammatory response: a new therapeutic indication. Anesthesiology. 2000;93:858–75.

Lahav M, Levite M, Bassani L. Lidocaine inhibits secretion of IL-8 and IL-1beta and stimulates secretion receptor antagonist by epithelial cells. ClinExpImmunol. 2002;127:226–33.

Sinclair R, Eriksson AS, Gretzer C, et al. Inhibitory effects of amide local anesthetics on stimulus-induced human leukocyte metabolic activation, LTB4 release and IL-1 secretion in vitro. Acta Anaesthesiol Scand. 1993;37:159–65.

Sanders RD, Xu J, Shu Y, Januszewski A, Halder S, Fidalgo A, Sun P, Hossain M, Ma D, Maze M. Dexmedetomidine attenuates isoflurane-induced neurocognitive impairment in neonatal rats. Anesthesiology. 2009;110:1077–85.

Li B, Li Y, Tian S, Wang H, Wu H, Zhang A, et al. Anti-inflammatory effects of perioperative dexmedetomidine administered as an adjunct to general anesthesia: a meta-analysis, Sci. Rep. 5(2015):12342.

Kuru S, Bozkirli OB, Barlas AM, Duymus ME, Senes M, Yumusak N, et al. The preventive effect of dexmedetomidine against postoperative intra-abdominal adhesions in rats, Int. Surg. 2015;100(1):87–95.

Liu YE, Tong CC, Zhang YB, Jin HX, Gao Y, Hou MX. Effect of dexmedetomidine on rats with renal ischemia-reperfusion injury and the expression of tight junction protein in kidney, Int. J. Clin. Exp. Med. 2015;8(10):18751–7.

Riquelme JA, Westermeier F, Hall AR, Vicencio JM, Pedrozo Z, Ibacache B, et al. Dexmedetomidine protects the heart against ischemia-reperfusion injury by an endothelial eNOS/NO-dependent mechanism, Pharmacol. Res. 2016;103:318–27.

Xin Y, Xie K, Xie H. Effects of Dexmedetomidine on Survival Rate, IL-6, and IL-10 of Rats with Sepsis. Sepsis. 2012;5:020.

Yun SH, Park JC, Kim SR, Choi YS. Effects of Dexmedetomidine on Serum Interleukin-6, Hemodynamic Stability, and Postoperative Pain Relief in Elderly Patients under Spinal Anesthesia. ActaMedica Okayama. 2016;70(1):37-43.

Farghaly HS, Mahmoud AM, Abdel-Sater KA. Effect of dexmedetomidine and cold stress in a rat model of neuropathic pain: Role of interleukin-6 and tumor necrosis factor-α. European journal of pharmacology. 2016;776:139-45

Ebrahimpour A, Okhovatpour MA, Sadighi M, Sarejloo AH, Sajjadi MR. Comparative investigation of percutaneous plating and intramedullary nailing effects on IL-6 production in patients with tibia shaft fracture. Actaorthopaedicaettraumatologicaturcica. 2017;51(6):478-81.

Dickstein R, Kiremidjian-Schumacher L, Stotzky G. Effects of lidocaine on the function of immunocompetent cells. I. In vitro exposure of mouse spleen lymphocytes and peritoneal macrophages. Immunopharmacology. 1985 Jun 1;9(3):117-25.

Giddon DB, Lindhe J. In vivo quantitation of local anesthetic suppression of leukocyte adherence. The American journal of pathology. 1972 Aug;68(2):327.

MacGregor RR, Thorner RE, Wright DM. Lidocaine inhibits granulocyte adherence and prevents granulocyte delivery to inflammatory sites. Blood. 1980 Aug 1;56(2):203-9.

Martinsson T, Oda T, Fernvik E, Roempke K, Dalsgaard CJ, Svensjö E. Ropivacaine inhibits leukocyte rolling, adhesion and CD11b/CD18 expression. Journal of Pharmacology and Experimental Therapeutics. 1997 Oct 1;283(1):59-65.

Sinclair R, Eriksson AS, Gretzer C, Cassuto J, Thomsen P. Inhibitory effects of amide local anaesthetics on stimulus‐induced human leukocyte metabolic activation, LTB4 release and IL‐1 secretion in vitro. Acta anaesthesiologica scandinavica. 1993 Feb;37(2):159-65.

Taniguchi T, Shibata K, Yamamoto K et al. Effects of lidocaine administration on hemodynamics and cytokine responses to endotoxemia in rabbits. Crit Care Med 2000; 28:755–9

DOI: https://doi.org/10.22037/jcma.v3i3.21115


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