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.
Yardeni
Israel Z
IZ
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.
Shavit
Yehuda
Y
Bessler
Hanna
H
Mayburd
Eduard
E
Grinevich
Galina
G
Beilin
Benzion
B
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