Inhibition of plasma cyclic AMP, glucose and cortisol response to surgery by epidural analgesia

Abstract

Cyclic AMP, glucose and cortisol in plasma were measured in three groups of patients undergoing hysterectomy. The operations were performed under general anaesthesia, under general anaesthesia combined with epidural analgesia and under epidural analgesia alone. Surgery elicited a significant rise in plasma cyclic AMP, glucose and cortisol when performed under general anaesthesia alone. Epidural analgesia extending from T4-6 to S5 combined with general anaesthesia abolished the rise in cyclic AMP and reduced the increase in glucose and cortisol and epidural analgesia alone extending from T4 to S5 blocked the rise in glucose and cortisol as well as that in cyclic AMP. The results support the theory that afferent nerve impulses from the area of trauma are of major importance for the catabolic state induced by surgical procedures and indicate that anaesthetic management which includes blockade of afferent nerve impulses which includes blockade of afferent nerve impulses from the area of trauma can be reduce the catabolic response to surgery. These observations could be of value in the operative management of patients with diabetes mellitus and possibly in other groups by patients with a high surgical morbidity.

The effect of epidural analgesia on postoperative sodium balance

“…The cortisol response was delayed in the epidural group, and although it was only delayed for i n patients undergoing uncomplicated cholecystectomy and receiving 90 mmol of Na daily; confirmation was found, however, of the delay of the cortisol response and reduction of the hypergiycaemic response to surgery by the epidural. a few hours, this result is very similar to that found in other studies (Lush et al, 1972;Gordon et al, 1973;Cosgrove and Jenkins, 1974) ; similarly the suppression of the byperglycaemic response is very similar to that found bly other workers (Bromage et al, 1971 ;Brandt et al, 1176;Madsen et al, 1977). On the basis of this evidence it seems reasonable to conclude that there was an effective blockade throughout the period of study.…”

“…Although this reported effect of epidural analgesia has not been re-examined until now, many other studies of the effects of epidural blockade in the perioperative period have been carried out; it has been shown that an epidural block will delay the plasma cortisol response to surgery (Lush et al, 1972;Gordon et al, 1973;Cosgrove and Jenkins, 1974), will diminish the usual rise in blood glucose (Bromage et al, 1971 ;Brandt et al, 1976;Madsen et al, 1977), reduce the negative nitrogen balance (Brandt et al, 1978) as well as affecting the initial postoperative changes in fibrinolysis (Engquist et al, 1976). Thus it seems that epidural blockade may have a fundamental effect in modifying many of the metabolic and endocrine responses to surgery, possibly by interrupting painful stimuli from the operation site.…”

Progressive decrease in glucose clearance during surgery

“…The operations that constituted major surgery were diverse, ranging from hemicolectomy to open repair of an aortic aneurysm. The major surgery group differed from the others in demographic respects and also in the fact that, according to our clinical routine, they received epidural analgesia, which is known to reduce the hyperglycaemic response to surgery (10, 11).…”

METABOLIC EFFECTS OF OBSTETRIC REGIONAL ANALGESIA AND OF ASPHYXIA IN THE NEWBORN INFANT DURING THE FIRST TWO HOURS AFTER BIRTH: I. Arterial Blood Glucose Concentrations

“…10). No increased occurrence of hypoglycaemia was noted by that the adrenocortical response during surgery is modified or abolished by epidural block (33)(34)(35). Cortisol is known to stimulate gluconeogenesis (cf.…”