Comparison of postoperative pain management techniques on endocrine response to surgery: a randomised controlled trial.
The present study compared three postoperative pain management techniques in patients undergoing lower abdominal surgery: intermittent opiate regimen (IOR), patient-controlled analgesia (PCA), and patient-controlled epidural analgesia (PCEA), on cortisol and prolactin levels during the first 48 h postoperatively. Ninety-two patients scheduled for a lower abdominal surgery, were randomly assigned to one of three study groups: IOR (N=31), PCA (N=31), and PCEA (N=30). Patients of the IOR group received postoperatively 50-75 mg of pethidine IM on demand. Patients of the PCA group received a loading dose of morphine (3-4 mg), followed by 1mg bolus of morphine IV per demand. Patients of the PCEA group received 3 ml of 0.1% bupivacaine plus 2 microg/ml of fentanyl per demand, with continuous background infusion of 6ml/h. Venous blood samples were collected preoperatively, and 24 and 48 h after surgery, and were later assayed for serum cortisol and prolactin levels. Patients of the PCEA group exhibited diminished postoperative elevation of serum cortisol levels at 24 and 48 h (24.4, 18.6 microg/dl, respectively) compared with both IOR (31.9, 21.9) and PCA (28.5, 22.3) groups. Similarly, patients of the PCEA group exhibited diminished postoperative elevation of serum prolactin level (20.7, 15.7 ng/mL) compared with PCA (24.9, 17.1) group. The present results indicate that the PCEA technique offers an advantageous treatment associated with reduced postoperative pain, and attenuated neuroendocrine response.
Department of Anaesthesiology, Rabin Medical Center, Golda-Hasharon Campus, Petah Tiqva 49372, Affiliated with the Sackler School of Medicine, Tel-Aviv University, Ramat Aviv, Israel.
Israel Z
IZ
Yardeni
Yehuda
Y
Shavit
Hanna
H
Bessler
Eduard
E
Mayburd
Galina
G
Grinevich
Benzion
B
Beilin
D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural / Q000379:methods*; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000704:Analysis of Variance; D000768:Anesthesia, General; D002045:Bupivacaine / Q000627:therapeutic use; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008614:Meperidine / Q000627:therapeutic use; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000276:immunology; D011388:Prolactin / Q000097:blood; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D009020:Morphine; D011388:Prolactin; D008614:Meperidine; D005283:Fentanyl; D006854:Hydrocortisone; D002045:Bupivacaine