Sympathetic blockade in a canine model of gram-negative bacterial peritonitis.
We investigated, in a well-established canine model of human sepsis, the effects of two different techniques of sympathetic blockade during bacterial peritonitis on pain relief, hemodynamics, and survival rate. Twenty-two purpose-bred beagles (12-28 months old, weighing 10-12 kg) were studied. Fourteen animals received an epidural infusion of bupivicaine and morphine, and the other eight received either a celiac plexus block (n = 4) or a sham block (n = 4). Eighteen of the 22 animals received an intraperitoneal challenge of Escherichia coli (1-10 x 10(9) CFU kg(-1) body weight). At comparable doses of intraperitoneal-implanted E. coli (2.5-5 x 10(9) CFU kg(-1) body weight), the addition of sympathetic blockade produced a synergistic decrease in survival times (P = 0.002) and mean left ventricular ejection fraction (P = 0.008), and increase in creatinine levels (P = 0.02). There was also a significant increase in tumor necrosis factor (TNF) levels (P = 0.004) and decrease in blood endotoxin clearance (P = 0.006) associated with sympathetic blockade during sepsis. The celiac plexus-blocked animals had no improvement in pain scores, and subjectively looked clinically worse than animals with sepsis without a celiac plexus block. In contrast, the epidural block was effective in blocking the pain and discomfort associated with low lethality doses of intraperitoneal bacteria reflected by no increase in pain scores compared with animals not receiving bacterial challenge. This study shows that during severe bacterial peritonitis, maintenance of sympathetic tone irrespective of pain relief provided is necessary for clearance of bacterial toxins, control of proinflammatory mediator release, hemodynamic stability, and survival.
Solomon
Steven B
SB
National Institutes of Health, Bethesda, Maryland 20892, USA.
Banks
Steven M
SM
Gerstenberger
Eric
E
Csako
Gyorgy
G
Bacher
John D
JD
Thomas
Marvin L
ML
Costello
Rene
R
Eichacker
Peter Q
PQ
Danner
Robert L
RL
Natanson
Charles
C
D000818:Animals; D001794:Blood Pressure; D002045:Bupivacaine / Q000494:pharmacology; D002302:Cardiac Output / Q000187:drug effects; D004195:Disease Models, Animal; D004285:Dogs; D004926:Escherichia coli; D004927:Escherichia coli Infections / Q000503:physiopathology*; D016905:Gram-Negative Bacterial Infections / Q000473:pathology / Q000503:physiopathology*; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology*; D009020:Morphine / Q000494:pharmacology; D010146:Pain / Q000503:physiopathology*; D010147:Pain Measurement; D010538:Peritonitis / Q000382:microbiology / Q000473:pathology / Q000503:physiopathology*; D011651:Pulmonary Artery / Q000187:drug effects / Q000503:physiopathology; D012016:Reference Values; D013564:Sympathetic Nervous System / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology*
D009020:Morphine; D002045:Bupivacaine