title: Comparative Evaluation of Pain, Stress, Neuropeptide Y, ACTH, and Cortisol Levels Between a Conventional Postoperative Care Protocol and a Fast-Track Recovery Program in Patients Undergoing Major Abdominal Surgery.
abstract: Fast-track (FT) postoperative protocol in oncological patients after major abdominal surgery reduces complications and length of postoperative stay compared to the conventional (CON) protocol. However, stress and pain responses have not been compared between the two protocols.
  
  
  
  To compare stress, pain, and related neuropeptidic responses (adrenocorticotropic hormone [ACTH], cortisol, and neuropeptide Y [NPY]) between FT and CON protocols.
  
  
  
  A clinical trial with repeated measurements was conducted (May 2012 to May 2014) with a sample of 63 hepatectomized or pancreatectomized patients randomized into two groups: FT ( n = 29) or CON ( n = 34). Demographic and clinical data were collected, and pain (Visual Analog Scale [VAS] and Behavioral Pain Scale [BPS]) and stress responses (3 self-report questions) assessed. NPY, ACTH, and cortisol plasma levels were measured at T1 = day of admission, T2 = day of surgery, and T3 = prior to discharge.
  
  
  
  ACTHT1and ACTHT2levels were positively correlated with self-reported stress levels (ρ = .43 and ρ = .45, respectively, p < .05) in the FT group. NPY levels in the FT group were higher than those in the CON group at all time points ( p ≤ .004); this difference remained significant after adjusting for T1 levels through analysis of covariance for age, gender, and body mass index ( F = .003, F = .149, F = .015, respectively, p > .05).
  
  
  
  Neuropeptidic levels were higher in the FT group. Future research should evaluate this association further, as these biomarkers might serve as objective indicators of postoperative pain and stress.
authors.affiliation: 1 Hellenic Anticancer Institute, Saint Savvas Hospital, Athens, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Kapritsou
authors.affiliation: 2 Nursing Department, University of Alberta, Edmonton, Canada.
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Papathanassoglou
authors.affiliation: 3 Pediatric Research Laboratory, Department of Nursing, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Bozas
authors.affiliation: 1 Hellenic Anticancer Institute, Saint Savvas Hospital, Athens, Greece.
authors.forename: Dimitrios P
authors.initials: DP
authors.lastname: Korkolis
authors.affiliation: 4 Department of Nursing, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Evangelos A
authors.initials: EA
authors.lastname: Konstantinou
authors.affiliation: 4 Department of Nursing, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Kaklamanos
authors.affiliation: 4 Department of Nursing, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Margarita
authors.initials: M
authors.lastname: Giannakopoulou
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood*; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D006115:Greece; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009478:Neuropeptide Y / Q000097:blood*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D010180:Pancreatectomy / Q000009:adverse effects; D011182:Postoperative Care / Q000379:methods*; D013315:Stress, Psychological / Q000188:drug therapy*; D013997:Time Factors
chemical_list: D015415:Biomarkers; D009478:Neuropeptide Y; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone
keywords: fast-track protocol; hepatectomy; major abdominal surgery; neuropeptide Y; pancreatectomy; postoperative stress and pain