title: Epidural analgesia attenuates the systemic stress response to upper abdominal surgery: a randomized trial.
abstract: The effects of combined general anaesthesia and epidural analgesia in various endocrine and metabolic parameters were studied before, during, at the end, and 72 h after upper abdominal surgery, in an effort to further elucidate the role of epidural analgesia in the endocrine and metabolic response. 50 patients were randomly assigned into groups A and B, which received general anaesthesia alone and combined general anaesthesia and epidural analgesia, respectively. The effects of surgical stress in the plasma concentration of ACTH (P <0.001), cortisol (P <0.01), aldosterone (P <0.05), FFA (P <0.05) and glucose (P <0.01) were significantly less pronounced in the group of patients who received combined general anaesthesia and epidural analgesia. However, there were no significant differences between the two groups in regard with plasma TSH, T3, T4, glucagon or Na+ concentration. These results indicate that the combination of general anaesthesia and epidural analgesia attenuate, but does not inhibit, the endocrine and metabolic response to upper abdominal surgery.
authors.affiliation: 2nd Department of Propedeutic Surgery, Laikon General Hospital, Athens University, Greece. gkouraklis@hotmail.com
authors.forename: G
authors.initials: G
authors.lastname: Kouraklis
authors.forename: A
authors.initials: A
authors.lastname: Glinavou
authors.forename: L
authors.initials: L
authors.lastname: Raftopoulos
authors.forename: V
authors.initials: V
authors.lastname: Alevisou
authors.forename: G
authors.initials: G
authors.lastname: Lagos
authors.forename: G
authors.initials: G
authors.lastname: Karatzas
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000450:Aldosterone / Q000097:blood; D000767:Anesthesia, Epidural / Q000009:adverse effects / Q000379:methods*; D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods*; D001786:Blood Glucose / Q000032:analysis; D001795:Blood Pressure Determination; D002763:Cholecystectomy / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008875:Middle Aged; D011184:Postoperative Period; D011300:Preoperative Care; D011336:Probability; D012016:Reference Values; D013312:Stress, Physiological / Q000453:epidemiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D000450:Aldosterone; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone