title: Analgesia and endocrine surgical stress: effect of two analgesia protocols on cortisol and prolactin levels during abdominal aortic aneurysm endovascular repair.
abstract: OBJECTIVE
  Endovascular abdominal aortic aneurysm (AAA) repair was performed with local anaesthesia and intravenous analgesia. The objective of the study was to evaluate how two analgesia protocols affected stress response, measured as cortisol, 17-OH progesterone (17OHP) and prolactin (PRL) concentration during the procedure.
  
  
  METHODS
  44 patients undergoing elective AAA endovascular repair were included to either receive regular boluses of fentanyl midazolam or remifentanil continuous infusion, analgesia was monitored by Visual Analogue Scale (VAS) measurement; cortisol, 17OHP and PRL were sampled preoperatively, at skin incision, endovascular prosthesis release and skin suture.
  
  
  RESULTS
  42 patients were included. Mean VAS values were lower in the remifentanil group 0.50±0.68 vs 1.48±1.20, p=0.002 at incision, 0.24±0.58 vs 1.45±1.18, p<0.001 prosthesis release, 0.51±0.90 vs 1.73±1.45, p=0.002 suture. No statistically significant difference was found among cortisol and 17OHP levels; PRL was significantly lower in the fentanyl-midazolam group (23.83±16.92 ng/ml vs 40.81±22.45 p=0.009 at prosthesis release and 28.23±15.05 vs 41.37±14.54, p=0.007 at suture).
  
  
  CONCLUSIONS
  Although statistically significant VAS difference had a limited clinical impact due to its small entity. The group that experienced less pain showed a more intense PRL response, while cortisol and 17OHP did not reach statistical significance.
authors.affiliation: University of Modena and Reggio Emilia, Modena, Italy. alberto.barbieri@unimore.it
authors.forename: Alberto
authors.initials: A
authors.lastname: Barbieri
authors.forename: Enrico
authors.initials: E
authors.lastname: Giuliani
authors.forename: Alessandro
authors.initials: A
authors.lastname: Genazzani
authors.forename: Enrica
authors.initials: E
authors.lastname: Baraldi
authors.forename: Anna
authors.initials: A
authors.lastname: Ferrari
authors.forename: Roberto
authors.initials: R
authors.lastname: D'Amico
authors.forename: Gioachino
authors.initials: G
authors.lastname: Coppi
mesh_terms: D019326:17-alpha-Hydroxyprogesterone / Q000097:blood; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D057510:Endovascular Procedures / Q000379:methods; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007432:Intraoperative Period; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy* / Q000378:metabolism; D010880:Piperidines / Q000008:administration & dosage*; D011388:Prolactin / Q000097:blood; D000077208:Remifentanil; D013312:Stress, Physiological / Q000187:drug effects*
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D010880:Piperidines; D019326:17-alpha-Hydroxyprogesterone; D011388:Prolactin; D000077208:Remifentanil; D008874:Midazolam; D005283:Fentanyl; D006854:Hydrocortisone