title: Effects of epidural preemptive analgesia on stress reaction in retroperitoneal laparoscopic adrenalectomy surgery: a randomized controlled study.
abstract: OBJECTIVE
  To compare the effects of general anesthesia combined with epidural preemptive analgesia with general anesthesia on stress reaction in the retroperitoneal laparoscopic surgery.
  
  
  METHODS
  Forty patients with adrenal tumors undergoing retroperitoneal laparoscopic surgeries were randomly assigned into general anesthesia combined with epidural preemptive analgesia group (GE) and general anesthesia group (G). Each group had 20 cases. In the GE group, before the induction of general anesthesia, T10-T11 epidural puncture was performed and 0.2% bupivacaine 5-10 ml was injected to maintain the anesthesia level at T4. In the G group, normal saline was injected as control. After entry into the operation room (X0), before surgery (X1), 30 min after pneumoperitoneum (X2), 60 min after pneumoperitoneum (X3), 10 min after extubation (X4), the mean arterial pressure (MAP) and heart rate (HR) were recorded. The concentration of plasma endothelin (ET) and calcitonin gene-related peptide (CGRP) were detected. Meanwhile, isoflurane inhalation MAC and intervention situations were recorded.
  
  
  RESULTS
  At X1-X3, MAP in the GE group was significantly lower than that in the G group (P < 0.05). At X2-X4 HR in two groups was significantly faster than at X1 (P < 0.05). At X4 HR in the GE group was significantly lower than that in the G group (P < 0.05). At X3 and X4, ET and CGRP were significantly lower than those in the G group (P < 0.05). At X2 and X3, ET in the GE group was significantly higher than that at X1 (P < 0.05). At X3, CGRP in the GE group was significantly higher than that at X1 (P < 0.05). At X2, X3 and before pneumoperitoneum, isoflurane MAC in the GE group was significantly lower than that in the G group (P < 0.05). At X2 and X3, isoflurane MAC in two groups was significantly higher than that during pneumoperitoneum (P < 0.05).
  
  
  CONCLUSIONS
  Compared with general anesthesia, general anesthesia combined with epidural preemptive analgesia can effectively alleviate patients' stress reaction under retroperitoneal laparoscopic surgery.
authors: Department of Anesthesiology, Nanjing Medical University Affiliated Wuxi Second Hospital 68 Zhongshan Road, Wuxi, China.
authors: Yun-Song
authors: YS
authors: Pan
authors: Department of Anesthesiology, Nanjing Medical University Affiliated Wuxi Second Hospital 68 Zhongshan Road, Wuxi, China.
authors: Yi-Feng
authors: YF
authors: Hu
authors: Department of Anesthesiology, Shanghai Obstetrics and Gynecology Hospital, Fudan University 128 Shenyang Road, Shanghai, China.
authors: Fu-Bo
authors: FB
authors: Tian
authors: Department of Anesthesiology, Nanjing Medical University Affiliated Wuxi Second Hospital 68 Zhongshan Road, Wuxi, China.
authors: Kai
authors: K
authors: Xu
keywords: Retroperitoneal laparoscopic surgery; preemptive analgesia; stress reaction