Favorable effects of epidural analgesia on hemodynamics, oxygenation and metabolic variables in the immediate post‐anesthetic period

Abstract

Fourteen adult patients undergoing elective major abdominal surgery were divided into two groups. One group received epidural and general anesthesia (epidural group), and 20 ml of 0.125% bupivacaine and 2 mg of morphine were administered epidurally about 30 min before the end of the operation for post-anesthetic analgesia. The other group (control group) received general anesthesia alone with nitrous oxide, oxygen and enflurane. Flow-directed pulmonary arterial and radial arterial catheters were inserted preoperatively, and hemodynamic, respiratory, neuroendocrine and metabolic variables were measured serially. The data were compared during anesthesia and the immediate post-anesthetic recovery period. In the control group, the plasma epinephrine level in the post-anesthetic recovery period increased about four times over the anesthetic period. Oxygen consumption was increased and mixed venous oxygen saturation was decreased significantly. There was a close linear correlation between oxygen consumption (Y) and plasma epinephrine (X) level: Y = 285.7X + 90.5 (P < 0.01, r = 0.72). On the other hand, plasma epinephrine, oxygen consumption and mixed venous oxygen saturation did not change significantly in the epidural group in the post-anesthetic recovery period. There was also a close linear correlation between oxygen consumption (Y) and oxygen delivery (X): Y = 0.22X-32.0 (P < 0.01, r = 0.89). We conclude that the surgical stress and anesthetic reversal may seriously influence neuroendocrine responses and subsequently increase plasma epinephrine. Tissue oxygenation and metabolic imbalance may occur due to the rapid increase of epinephrine in the post-anesthetic recovery period. Epidural analgesia at this period may play a more important role and have a more favorable effect on the tissue metabolism.

Epidural analgesia improves early rehabilitation after total knee replacement

“…The stress response can lead to the increase of platelet aggregation, fibrinogen levels, and the decrease of antithrombin III levels as well. Attenuation of stress response by epidural analgesia can lead to the decrease in production of catecholamines and cortisol, which can ameliorate thrombogenic effects [9,10]. It has also been shown that epidural bupivacaine 0.5% has a direct inhibitory effect on platelet aggregation [11].…”

“…Epidural analgesia increases lower limb blood flow and decreases factor VIII activity [4]. The stress response induced by surgery leads to the increase of catecholamines, cortisol, and angiotensin levels (secondary to higher renin activity) [9,10]. The stress response can lead to the increase of platelet aggregation, fibrinogen levels, and the decrease of antithrombin III levels as well.…”

Neuraxial Blocks: Spinal and Epidural Anesthesia

“…This effect is greater for a lumbar epidural than a thoracic epidural [ 42 ]. The magnitude of the stress response correlates with postoperative morbidity, and thus, its attenuation should be of benefi t [ 43 ].…”

A comparison of extradural tramadol and extradural morphine for postoperative analgesia in female dogs undergoing ovariohysterectomy

“…In both treatments groups, serum cortisol did not exceed the reference range (0.96 to 6.81 mg/dl) at any evaluated time point. In humans, extradural administration of opioids has been shown to have favorable effects on metabolites and hormonal variables in the immediate postoperative period 28 . Previous studies have reported that dogs receiving ED morphine 29 or ED methadone 3 have lower postoperative serum cortisol levels than those receiving the same analgesic by IV administration.…”