Thoracic epidural analgesia in aortocoronary bypass surgery II: effects on the endocrine metabolic response

Abstract

Thoracic epidural analgesia (TEA) may offer haemodynamic benefits for patients with coronary heart disease going through major surgery. This may-in part-be secondary to an effect on the endocrine and metabolic response to surgery. We therefore investigated the effect of TEA on the endocrine metabolic response to aortocoronary bypass surgery (ACBS). Thirty male patients (age < 65 years, ejection fraction > 0.5) were randomized into 3 groups; the HF group receiving a high dose fentanyl (55 micrograms.kg-1) anaesthesia, the HF+TEA group with the same fentanyl dose+TEA with 10 ml bupivacain 5 mg.ml-1, followed by 4 ml every hour, and the LF+TEA group receiving fentanyl 15 micrograms.kg-1 + TEA. Adrenalin, noradrenalin, systemic vascular resistance (SVR), glucose, cortisol, lactate and free fatty acids were followed during the operation and for 20 h postoperatively. A significant increase in adrenalin, noradrenalin and SVR was found in the HF group whereas this increase was blocked in both epidural groups. An increase in glucose and cortisol was noticed in all groups, but the increase was delayed in the epidural groups. Our results suggest that a more effective blockade of the stress response during ACBS is obtained when TEA is added to general anaesthesia than with high dose fentanyl anaesthesia alone.

Effects of thoracic epidural analgesia on glucose homeostasis after cardiac surgery in patients with and without diabetes mellitus

“…Moore found that with TEA there was no increase in B-glu and catecholamine, and cortisol responses were blunted until at least 24 h after CPB [11]. Stenseth showed that TEA blunted and delayed the increase in glucose and cortisol after CABG [12]. Curiously, Richardson showed that continuous paravertabral anaesthesia could prevent hyperglycaemia after a thoracotomy while TEA could not [13].…”

The benefits of adding epidural analgesia to general anesthesia: a metaanalysis

“…Thirty-one studies were used for measurements of epinephrine, norepinephrine, cortisol, and glucose blood concentrations; for 13 studies there was no information available on blood loss and/or blood transfusion; for nine studies, no patient was transfused; for one study there was no difference in the number of units transfused; and for five studies there was no statistical difference in the amount of estimated blood loss. For three studies there was a statistical difference either in estimated blood loss [10,64] or in intraoperative hematocrit [45]. If these last three studies were excluded from the analysis, the * P < 0.05.…”

The influence of dexmedetomidine on opioid consumption in radical prostatectomy

“…(3,4) Epidural analgesia reduces the endocrine and metabolic stress response, facilitates early gut mobility, decreases wound infections and postoperative respiratory complications. (3,(5)(6)(7)(8)(9) Given that epidural catheter insertion is an invasive method associated with complications, and that prostatic cancer patients are older, often with comorbidites, degenerative spine changes and on anticoagulants, this method is often avoided. (10) Only opioid based pain relief is associated with adverse reactions (insufficient breathing, nausea, vomiting, constipation, ileus, drowsiness); also, acute tolerance to opioids may develop intraoperatively.…”