Epidural anesthesia can protect fibrinolytic function after surgery.
OBJECTIVE
To study the influences of different anesthesia techniques on stress response, coagulation and fibrinolytic function.


METHODS
Thirty patients undergoing hysterectomy were randomized into three groups: Group E (continuous epidural anesthesia, n=10), Group G+E (epidural anesthesia combined general anesthesia, n=10) and Group G (general anesthesia, n=10). The blocking level with epidural anesthesia was maintained between T(6)-L(3) with 0.75% bupivacaine followed by Patient  Controlled Epidural Analgesia (PCEA). General anesthesia was finished with convention followed by Patient-Controlled Analgesia (PCA). Blood samples were taken at pre-anesthesia (T(0)), the end of operation (T(1)) and postoperative 24 h (T(2)), 72 h (T(3)) to determine catecholamine concentration, coagulation and fibrinolysis variables.


RESULTS
The nonepinephrine (NE) levels in Group E and Group G+E were not changed throughout the procedure, but obviously elevated in Group G (P<0.01) as compared with the baseline and those in the other Groups (P<0.05). The epinephrine (E) levels at T(1) in all groups were markedly increased as compared with those at T(0) and peaked (P<0.01), and then returned to the baseline at T(3). Fibrinogen (FIB) levels in all groups were obviously decreased at T(1), postoperatively elevated rapidly and peaked at T(3) (P<0.01). FIB levels at T(3) in groups G+E and G were much higher than that in Group E (P<0.05). The thrombin-anti-thrombin III complex (TAT) levels at T(1) in Group G+E and G were significantly increased as compared with those at Group E (P<0.01), and subsequently recovered to pre-anesthesia following surgery. TAT level in Group E was more decreased postoperatively than the baseline and those in the other groups (P<0.05). The D-dimer level in Group E over time was remarkably increased as compared with the baseline (P<0.05), and the D-dimer levels peaked at T(2) in all groups (P<0.01). The tissue-type plasminogen activator (t-PA) was more elevated than T(0) at T(1) (P<0.01) in all groups, and then returned to normal in Group E. But the marked decrease of t-PA in Groups G+E and G was revealed 72 h after surgery and became much lower than that in Group E (P<0.01). The plasminogen activating inhibitor-1(PAI-1) in Group G and Group G+E was more elevated perioperatively and became higher than that in Group E (P<0.01).


CONCLUSIONS
Epidural anesthesia can preserve fibrinolytic function after lower-abdomen surgery by the inhibitory effects on surgical stress, PAI-1 and other mechanisms. The thromboprophylactic effects are revealed only following epidural anesthesia.
Wang
Tian-long
TL
Department of Anesthesia, Peking University People's Hospital, Beijing 100044, China. w_tl5595@hotmail.com
Qi
Yan-qin
YQ
Yang
Ba-xian
BX
Zhao
Lei
L
D000328:Adult; D015360:Analgesia, Epidural; D000767:Anesthesia, Epidural / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D001794:Blood Pressure; D002045:Bupivacaine / Q000008:administration & dosage*; D004837:Epinephrine / Q000097:blood; D005260:Female; D005342:Fibrinolysis / Q000502:physiology*; D006339:Heart Rate; D006801:Humans; D007044:Hysterectomy; D009638:Norepinephrine / Q000097:blood; D010314:Partial Thromboplastin Time; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D011183:Postoperative Complications / Q000097:blood / Q000503:physiopathology / Q000517:prevention & control*; D013927:Thrombosis / Q000097:blood / Q000517:prevention & control
D000779:Anesthetics, Local; D017395:Plasminogen Activator Inhibitor 1; D009638:Norepinephrine; D002045:Bupivacaine; D004837:Epinephrine