[A profound stress reaction during epidural opiate analgesia in combination with weak neuroleptanalgesia in comparison with neuroleptanesthesia Type II alone].
The modifying influence of anaesthetic procedures on stress reaction linked to operating trauma was observed by measurement of plasma concentration of beta-endorphin. In a prospective study 54 patients undergoing a radical gynaecological operation were allocated to either neuroleptanaesthesia type II or epidural morphine analgesia combined with slight neuroleptanaesthesia. The observation period was extended from the first preoperative day to the first postoperative day and included 11 measurements. The plasma concentration of beta-endorphin was determined by radioimmunoassay technique. At the beginning of the operation both groups of patients showed a significant increase in the plasma concentration of beta-endorphin, with the peak value occurring at the end of the operation. The patients undergoing epidural morphine analgesia in combination with slight neuroleptanaesthesia reached about five times higher levels of plasma concentration of beta-endorphin than the patients receiving neuroleptanaesthesia type II. The results show that the systemic administration of opiates suppresses the excessive activation of neuroendocrine stress systems to a greater extent than epidural administration. These results may be explained by the assumed worse quality of antinociception by epidural administration of morphine. This is thought to be caused by the late administration of the drug, by the non-selective occupation of the spinal opioid receptors and by the inadequate activation of the diffuse descending inhibitory control systems. The role of supraspinal mechanisms involved in opiate analgesia is discussed.
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Abteilung für Anästhesiologie des Kreiskrankenhauses Dorothea Christiane Erxleben, Akademisches Lehrkrankenhaus der Medizinischen Akademie Magdeburg.
D000328:Adult; D015360:Analgesia, Epidural; D005260:Female; D005831:Genital Diseases, Female / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D009020:Morphine; D009458:Neuroleptanalgesia / Q000009:adverse effects*; D011446:Prospective Studies; D013312:Stress, Physiological / Q000139:chemically induced / Q000209:etiology*
D009020:Morphine
Profunde Stressreation unter epiduraler Opiatanalgesie in Kombination mit flacher Neuroleptanästhesie im Vergleich zur alleinigen Neuroleptanästhesie Typ II.