Effect of Epidural Analgesia on the Glycoregulatory Endocrine Response to Surgery

Abstract

Plasma concentrations of glucose, insulin, glucagon, cortisol, growth hormone and prolactin were measured repeatedly in ten females undergoing abdominal hysterectomy during general anaesthesia. In addition to general anaesthesia five of the patients had continuous epidural analgesia effective for the first 26 postoperative hours. Plasma glucose was elevated during surgery and postoperatively, but not in patients having epidural analgesia. Insulin was low and unchanged in both groups. Glucagon was unchanged and similar in both groups. Cortisol was lower during surgery in the epidural group, but not postoperatively. Growth hormone increased during surgery in four of five patients receiving general anaesthesia alone, but no changes were observed in the epidural group. Prolactin was greatly elevated in all patients immediately after induction of anaesthesia and then fell rapidly during surgery, similarly in both groups. It is concluded that epidural analgesia can inhibit the hyperglycaemic response to surgical stress, but this effect cannot be uniformly correlated to changes in peripheral plasma levels of insulin, glucagon, cortisol, growth hormone or prolactin.

Effect of epidural analgesia on metabolic profiles during and after surgery

“…This effect is probably mediated through the inhibited adrenaline response or blockade of sympathetic pathways to the liver as discussed previously (Brandt, Kehlet, Binder et al, 1976).…”

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SUMMARYBLOCKADE of afferent neurogenic stimuli from the surgical area by epidural analgesia inhibits various parameters of the endocrine response to surgery, such as cortisol (Engquist et al, 1977), growth hormone (Brandt, Kehlet, Binder et al, 1976) and aldosterone and renin (Brandt, Olgaard et al, 1979), while postoperative changes in thyroid hormones (Brandt, Kehlet, Skovsted et al, 1976) are unaffected. Insulin secretion is probably slightly inhibited (Brandt, Kehlet and Binder, 1976;Brandt et al, 1977).

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“…Insulin secretion is probably slightly inhibited (Brandt, Kehlet and Binder, 1976;Brandt et al, 1977). Although the overall effect of epidural analgesia results in an improved postoperative nitrogen balance (Brandt, Fernandes et al, 1978), the influence on per-and postoperative metabolic profiles is unknown.…”

Prolactin, Growth Hormone, Thyrotropin, 3,5,3′-Triiodothyronine, and Thyroxine Responses to Exercise after Fat- and Carbohydrate-Enriched Diet*

“…Furthermore, it is suggested that GH secretion is more sensitive to a decrease in glucose and insulin levels than PRL secretion. (J Clin EndocrinolMetab 52: 56,1981) E XERCISE and other conditions of stress have been reported to increase the secretion of PRL and GH (1)(2)(3)(4). However, the stimuli for these responses are not known in detail.…”

Prolactin, LH, FSH, GH and cortisol response to surgery and the effect of epidural analgesia

“…Gonadotrophin concentrations were unchanged in the general anaesthesia group until 9 h after stimulation when levels decreased slightly. In contrast plasma gonadotrophin levels decreased immediately after the administration of epidural analgesia and during the following 9 h. It is concluded that neurogenic blockade inhibits the anterior pituitary response to surgial stress.Surgical stress has been shown to influence the secretion of the anterior pituitary hormones (Char¬ ters et al 1969;Noel et al 1972;Aono et al 1976;Brandt et al 1976;Wang et al 1978). The release mechanism of the endocrine-metabolic response is predominantly mediated through neurogenic sti¬ muli from the surgical area (Kehlet 1978).…”