Effects of Extradural Analgesia and Vagal Blockade on the Metabolic and Endocrine Response to Upper Abdominal Surgery

Abstract

The effect of thoracic extradural analgesia and vagal blockade on the metabolic and endocrine responses to cholecystectomy was investigated. In comparison with a control group of patients, extradural analgesia and vagal blockade abolished the glycaemic response but had no effect on the increase in plasma cortisol. Circulating insulin values were significantly decreased in the extradural group of patients, confirming the importance of autonomic innervation in maintaining basal insulin output. there is, at present, no satisfactory local analgesic technique for controlling the endocrine response to upper abdominal surgery.

Epidural blockade suppresses lipolysis during major abdominal surgery☆

“…The few studies, which have been undertaken so far, however, provide no conclusive evidence demonstrating either decreased or unchanged plasma concentrations of fatty acids and glycerol during epidural block. 6,8,9,15 Because plasma substrate concentrations are the result of the balance between substrate release into plasma and substrate tissue uptake, and because the relationship between plasma substrate concentration and kinetics varies markedly depending on the physiologic state, direct assessment of dynamic pathways is necessary to gain a better understanding of lipid metabolism.…”

Peripheral blockade as treatment of arm ischaemia at birth

“…Furthermore, it stops afferent impulses and inhibits peripheral vasoconstriction because of a reduction of the pain-induced release of catecholamines, cortisol and antidiuretic hormone [10]. The efficacy of PNB has been described both to induce vasodilatation after LI due to brachial artery cannulation [4,9] and also as an alternative therapeutic approach in neonates with thrombosis when standard fibrinolytic treatment is contraindicated [5].…”

Peripheral Nerve Blockade and Neonatal Limb Ischemia

“…Furthermore, it stops afferent impulses and inhibits peripheral vasoconstriction because of a reduction in the pain-induced release of catecholamines, cortisol, and antidiuretic hormone. 16 This procedure was also successfully used by Hargreaves and coworkers in a preterm neonate (29 weeks of gestation) with aortic thrombosis triggered by umbilical catheterization. 17 In this case, antithrombotic therapy was contraindicated because of the preexisting intraventricular hemorrhage (IVH).…”