title: Large-dose intrathecal sufentanil prevents the hormonal stress response during major abdominal surgery: a comparison with intravenous sufentanil in a prospective randomized trial.
abstract: We studied the effect of large-dose intrathecal sufentanil (ITS) for major abdominal surgery on the hormonal stress response. Forty patients were randomly allocated to receive either IV sufentanil (IVS) or 150 microg of ITS as part of general anesthesia. In the IVS group, adrenocorticotropic hormone (ACTH) and cortisol concentrations were larger than baseline and the ITS group, 60 min after incision and at skin closure. Plasma concentrations of cortisol and ACTH were not different from baseline in the ITS group during surgery. Six hours after skin closure, cortisol concentrations were larger than baseline in both groups. Twenty-four and 48 h after skin closure, ACTH and cortisol values were similar between groups. Norepinephrine concentrations increased after surgery in both groups. Blood glucose levels increased in both groups during and after surgery. Pain scores and morphine consumption during the first 48 h after surgery were lower in the ITS group. The data show that large-dose ITS prevents the intraoperative hormonal stress response in comparison with balanced anesthesia. We speculate that this is due to the highly specific binding of sufentanil to spinal and supraspinal receptors. This technique improves postoperative analgesia when compared with balanced anesthesia.
authors.affiliation: *Department of Anaesthesiology, Diakonessenhuis Hospital, Utrecht, The Netherlands; and †Division for Perioperative and Emergency Medicine, University Medical Centre, Utrecht, The Netherlands.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Borgdorff
authors.forename: Traian I
authors.initials: TI
authors.lastname: Ionescu
authors.forename: Peter L
authors.initials: PL
authors.lastname: Houweling
authors.forename: Johannes T A
authors.initials: JTA
authors.lastname: Knape
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000768:Anesthesia, General; D000771:Anesthesia, Intravenous; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000627:therapeutic use*; D001786:Blood Glucose / Q000378:metabolism; D002395:Catecholamines / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D006728:Hormones / Q000097:blood*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007275:Injections, Intravenous; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D011446:Prospective Studies; D013312:Stress, Physiological / Q000503:physiopathology / Q000517:prevention & control*; D017409:Sufentanil / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000701:Analgesics, Opioid; D018686:Anesthetics, Intravenous; D001786:Blood Glucose; D002395:Catecholamines; D006728:Hormones; D009020:Morphine; D000324:Adrenocorticotropic Hormone; D017409:Sufentanil; D006854:Hydrocortisone