The Blocking Effect of Epidural Analgesia on the Adrenocortical and Hyperglycemic Responses to Surgery

Engquist, A.; Brandt, M. R.; Fernandes, A.; Kehlet, Henrik

doi:10.1111/j.1399-6576.1977.tb01227.x

Cited by 238 publications

(60 citation statements)

References 9 publications

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“…We have previously observed a similar pattern in cyclic AMP, glucose and cortisol levels after surgery under Efrane anaesthesia (Nistrup Madsen et al, 1977;Engquist et al, 1977). These observations suggest that the major endocrine stress response in uncomplicated surgery of moderate severity occurs in the early postoperative phase.…”

Section: S Nistrup Madsensupporting

confidence: 66%

Cyclic AMP, adrenaline and noradrenaline in plasma during surgery

Madsen

Fog-Møller

Christiansen

et al. 1978

Journal of British Surgery

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Plasma concentrations of cyclic AMP, adrenaline and noradrenaline were measured in 6 patients undergoing hysterectomy from before induction of anaesthesia to 6 h after skin incision. Noradrenaline did not vary significantly during the observation period, whereas cyclic AMP and adrenaline increased after skin incision. A significant correlation was found between plasma concentrations of cyclic AMP and adrenaline (r = 0.84, P less than 0.01), suggesting that the latter is responsible for the increase in plasma cyclic AMP which is observed in relation to surgical procedures. Peak concentrations of cyclic AMP and adrenaline were seen in the early postoperative phase. This indicates that the most pronounced acute endocrine stress response to surgery of moderate severity occurs after termination of anaesthesia.

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Section: S Nistrup Madsensupporting

confidence: 66%

Cyclic AMP, adrenaline and noradrenaline in plasma during surgery

Madsen

Fog-Møller

Christiansen

et al. 1978

Journal of British Surgery

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“…However, in that study epidu¬ ral analgesia extended only to Ts which neither was sufficient to block the cortisol response to surgery. Therefore, sympathetic afferent pathways from T* to Ts which were blocked in the present study probably are an important pathway for the release of prolactin and cortisol to surgery (Engquist et al 1977). …”

Section: Discussionmentioning

confidence: 94%

“…Seven patients had general anaesthesia with halothane and six patients epidural analgesia only, induced by 0.5% bupivacaine without adrenaline (Marcaine®) as described previously (Engquist et al 1977). The analgesia, extend¬ ing from T4 to Ss, started before skin incision and was maintained throughout the following 24 h, constantly keeping the patients pain free.…”

Section: Methodsmentioning

confidence: 99%

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

Hagen

Brandt

Kehlet

1980

Acta Endocrinologica

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The prolactin, LH, FSH, growth hormone and cortisol responses to surgical stress were studied in female patients receiving halothane (general) anaesthesia or epidural analgesia. Plasma cortisol, prolactin, and growth hormone concentrations increased during surgery, and post-operatively in patients operated under general anaesthesia, but not in patients operated during 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).However, data on prolactin, LH and FSH re¬ sponses to surgery in women are very limited. In this study we describe the influence of neurogenic blockade on plasma prolactin, LH, FSH, growth hormone and cortisol responses to surgery in fe¬ male patients. Material and MethodsThirteen otherwise healthy, pre-menopausal women undergoing hysterectomy for menorrhagia or cervical cancer in stage 0-1 were studied. Age ranged from 26 to 48 years (average 41 years in the general anaesthesia group and 36 years in the epidural group). None had any signs of cardiac, hepatic, renal or endocrine disease, and none received any hormonal drugs including contracep¬ tives. Menstrual bleeding intervals were regular or slight¬ ly irregular. Two women receiving general anaesthesia and one epidural analgesia were studied in the late follicular phase of their menstrual cycle. All other pa¬ tients studied were in the mid-luteal phase of the cycle.All patients gave informed concept to participate. Seven patients had general anaesthesia with halothane and six patients epidural analgesia only, induced by 0.5% bupivacaine without adrenaline (Marcaine®) as described previously (Engquist et al. 1977). The analgesia, extend¬ ing from T4 to Ss, started before skin incision and was maintained throughout the following 24 h, constantly keeping the patients pain free. Both groups were premedicated with pethidine 1 mg/kg, promethazine 12.5-25 mg, and atropine 0.5 mg. The two groups were compar¬ able with regard to duration of operation (about 90 min), and no one received blood or blood substitutes other than isotonic saline during the study.Twelve blood samples were taken from a venous catheter: 15 and 10 min before anaesthesia or epidural analgesia, at skin incision, and at Vi, 1, 2, 3, 4, 6, 9, 14 and 24 h after skin incision. They were analysed for cortisol by a competitive protein binding technique (Kehlet et al.

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“…However, complete suppression of the stress response requires sympathetic and somatic blockade of the surgical site such as can be provided with extensive epidural anesthesia (T4-S5 to pinprick) [9]. Although less extensive blockade provides anesthesia, the stress response is incompletely blocked because of incomplete suppression of sympathetic and somatic signals [9,10].…”

Section: Effect Of Epidural Anesthesia On Stress Responsementioning

confidence: 99%

Regional Anesthesia and Analgesia: Their Role in Postoperative Outcome

Ekatodramis

2001

CTMC

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Increasing insight into the mechanisms of perioperative physiologic responses and the resultant effects on patient outcome suggests that some responses may be detrimental to long-term recovery. Thus, initial belief in the adaptive "wisdom" of the body [1] has been supplanted by the concept that a "stress-free" perioperative period may minimize detrimental physiologic responses and resultant morbidity [2].The perioperative use of neuraxial-or regional anesthesia and analgesia have profound inhibitory effects on the body's response to surgery compared to the same operation performed during general anesthesia alone. Increasing evidence has emerged suggesting that such afferent nociceptive blockade may improve a variety of postoperative morbidity parameters and improve surgical outcome. We review the clinical evidence from studies examining the effects of regional anesthesia and analgesia on postoperative morbidity in specific physiologic systems.

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The Blocking Effect of Epidural Analgesia on the Adrenocortical and Hyperglycemic Responses to Surgery

Cited by 238 publications

References 9 publications

Cyclic AMP, adrenaline and noradrenaline in plasma during surgery

Cyclic AMP, adrenaline and noradrenaline in plasma during surgery

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

Regional Anesthesia and Analgesia: Their Role in Postoperative Outcome

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