[The metabolic and hormonal effects of perioperative ibuprofen treatment on surgical stress].
BACKGROUND
Surgical stress induces hormonal and cytokine responses proportional to the extent of the injury. Perioperative administration of cyclo-oxygenase inhibitors reduces cytokine production and nitrogen losses. The objective of this study is to evaluate clinically the metabolic and hormonal effects of ibuprofen which is cyclo-oxygenase inhibitor on surgical stress.


METHODS
A prospective clinic study was performed in 20 patients who undergone thyroidectomy. Patients were randomly divided two groups as ibuprofen group (n = 10) and control group (n = 10). In the ibuprofen group, pills containing ibuprofen (400 mg) were administered orally 12 and 2 hours before surgery, and every 8 hours until the third postoperative day. In the both groups, blood samples were collected 24 and 2 hours before surgery and 1, 4, 6, 24, 48, and 72 hours after skin incision for glucose, CRP, leukocytes, ACTH, cortisol determinations.


RESULTS
When preoperative values were compared with postoperative values, surgical stress caused significantly changes on the all parameters in the both groups. The highest levels of ACTH and cortisol were at 1st and 6th hours respectively. In both groups, plasma cortisol levels remained elevated for 3 days, whereas plasma ACTH levels returned to the basal level at 1 day. In the ibuprofen group, the levels of ACTH and cortisol were significantly less than those of control group (p < 0.001 and p < 0.001). In the ibuprofen group glucose level (p < 0.001) and count leukocyte (p < 0.001) increased mildly. The level of CRP increased gradually after first day and were high until 3rd days (p < 0.01). In the ibuprofen group the fever increased smaller (p < 0.01).


CONCLUSIONS
In conclusion, in perioperative period pretreatment with ibuprofen is able to reduce the neuroendocrine and humoral responses, but it can not completely suppress. Our present study suggests that ibuprofen may be useful in decreasing the surgical stress response in the serious patients.
Aydin
Onder
O
Dicle Universitesi Tip Fakültesi Genel Cerrahi Anabilim Dali, Diyarbakir.
Aldemir
Mustafa
M
Taçyildiz
Ibrahim
I
Girgin
Sadullah
S
Sen
Tahir
T
Baç
Bilsel
B
D000284:Administration, Oral; D000324:Adrenocorticotropic Hormone / Q000097:blood / Q000187:drug effects; D000328:Adult; D001786:Blood Glucose / Q000187:drug effects; D002097:C-Reactive Protein / Q000187:drug effects / Q000378:metabolism; D016861:Cyclooxygenase Inhibitors / Q000008:administration & dosage* / Q000494:pharmacology; D005260:Female; D006728:Hormones / Q000097:blood*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007052:Ibuprofen / Q000008:administration & dosage* / Q000494:pharmacology; D007962:Leukocytes / Q000187:drug effects / Q000378:metabolism; D008297:Male; D009490:Neurosecretory Systems / Q000187:drug effects; D019990:Perioperative Care; D011446:Prospective Studies; D013312:Stress, Physiological / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D013965:Thyroidectomy
D001786:Blood Glucose; D016861:Cyclooxygenase Inhibitors; D006728:Hormones; D000324:Adrenocorticotropic Hormone; D002097:C-Reactive Protein; D006854:Hydrocortisone; D007052:Ibuprofen