Effect of low dose naloxone on the immune system function of a patient undergoing video-assisted thoracoscopic resection of lung cancer with sufentanil controlled analgesia — a randomized controlled trial

Abstract Background: Perioperative immune function plays an important role in the prognosis of patients. Several studies have indicated that low-dose opioid receptor blockers can improve immune function. Methods: Seventy patients undergoing video-assisted thoracoscopic resection of the lung cancer were randomly assigned to either the naloxone group (n=35) or the non-naloxone group (n=35) for postoperative analgesia during the first 48 hours after the operation. Both groups received sufentanil and palonosetron via postoperative analgesia pump, while 0.05μg·kg -1 ·h -1 naloxone was added in naloxone group. The primary outcomes were the level of opioid growth factor （OGF） and immune function assessed by natural killer cells and CD4 + /CD8 + . Second outcomes were assessed by the score of postoperative pain, postoperative rescue analgesia dose, postoperative nausea and vomiting (PONV). Results: The level of OGF in the naloxone group was significantly increased at 24 hours ( p ＜0.001) and 48 hours after the operation ( P <0.01). The natural killer cells ( P <0.05) and CD4+/CD8+ ( P <0.01) in the naloxone group increased significantly at 48 hours after the operation. The rest VAS score was better with naloxone at 12 and 24 hours after operation（ P <0.05）, and the coughing VAS score was better with naloxone at 48 hours after the operation（ P <0.05). The consumption of postoperative rescue analgesics in the naloxone group was lower (0.00（0.00-0.00）vs 25.00（0.00-62.50））， P <0.05). Postoperative nausea score at 24 hours after operation decreased in naloxone group（0.00 (0.00-0.00) vs 1.00 (0.00-1.00), P < 0.01). Conclusion: Infusion of 0.05μg·kg -1 ·h -1 naloxone for patients undergoing sufentanil-controlled analgesia for postoperative pain can significantly increase the level of OGF, natural killer cells, and CD4 + /CD8+ ，And also reduce the postoperative pain intensity, request for rescue analgesics, and opioid-related side effects. Trial registration: ChiCTR1900021043 on January 26, 2019.