Effect of Ropivacaine Epidural Block Combined with General Anesthesia on the Expression of Oxidative Stress and Immune Indexes in Elderly Patients with Ovarian Cancer Cell Cytoreductive Surgery

Background: Perioperative oxidative stress (OS) and immunosuppression can increase the risk of tumor metastasis and diminish treatment efficacy in ovarian cancer (OC). To enhance the efficiency of cytoreductive surgery (CS) and reduce surgical risks, the combination of ropivacaine epidural block (REB) with general anesthesia (GA) has emerged as a novel regimen, particularly for elderly patients undergoing OC surgery. However, there is limited research on the effectiveness of this protocol, underscoring the need for comprehensive investigation. This study aims to evaluate the impact of REB combined with GA on oxidative stress and immune parameters in elderly patients undergoing cytoreductive surgery for OC. Methods: Out of 124 eligible patients undergone OC cytoreductive surgery at Lanzhou First People’s Hospital (June 2022–December 2023), 79 patients received intravenous general anesthesia and 45 patients received ropivacaine epidural block combined with general anesthesia. Propensity score matching yielded 45 pairs. 45 patients given intravenous general anesthesia were included to the control group (CG), while 45 patients used ropivacaine epidural block combined with general anesthesia were included to the study group (SG). Perioperative recovery was assessed at multiple time points: 30 minutes preoperatively, during anesthesia induction, and at 5 and 30 minutes post-induction, as well as upon surgery completion. The parameters assessed included heart rate (HR), mean arterial pressure (MAP), C-reactive protein (CRP), OS indicators (cortisol, interleukin-6, and tumor necrosis factor-alpha [TNF-α]), and immune indicators (T lymphocyte subsets). Postoperative analgesic efficacy was measured using the visual analogue scale (VAS) and Bromage score. Additionally, adverse reactions within 48 hours post-surgery were monitored. Results: The SG exhibited significantly shorter times to respiratory recovery, awakening, and extubation, as well as a reduced need for remedial analgesia compared to the CG (p < 0.05). Furthermore, the SG demonstrated significant improvements in MAP, HR, OS markers, and immune parameters, alongside better VAS, and Bromage scores relative to the CG (p < 0.05). The incidence of adverse reactions was also lower in the SG (p < 0.05). Conclusion: The combination of REB with GA effectively shortens recovery times, reduces oxidative stress and immune suppression, enhances postoperative analgesia, and decreases the incidence of side effects. This regimen thereby ensures higher safety and improved outcomes in elderly patients undergoing surgery for ovarian cancer.