Influence of Epidural Analgesia on the Catecholamine and Cyclic AMP Responses to Surgery

Abstract

The effects of neurogenic block on plasma concentrations of adrenaline, noradrenaline and cyclic AMP were studied. Eighteen patients were subjected to surgery of moderate or minor extent under enflurance anesthesia with or without epidural analgesia. The results show that adrenaline secretion during surgical stress is a response to neurogenic stimuli, since the increase found in patients subjected to hysterectomy under general anesthesia is blocked by the addition of epidural analgesia. Furthermore, plasma adrenaline after neurogenic block is comparable with adrenaline levels during minor surgical stress. The plasma noradrenaline concentration does not correlate with the extent of trauma. In contrast to adrenaline levels, noradrenaline concentrations varied insignificantly during and after surgery. However, the addition of epidural block induced a postoperative increase in noradrenaline apparently unrelated to changes in heart rate or blood pressure. Simultaneous measurements of the catecholamines and cyclic AMP indicate that adrenaline is of minor importance for plasma cyclic AMP in resting patients, whereas the increase in cyclic AMP elicited by surgery reflects adrenaline-stimulated beta-adrenergic activity.

The Effect of General Anesthesia and General Anesthesia Plus Epidural Levobupivacaine or Bupivacaine on Hemodynami Stress Response and Postoperative Pain

“…Postoperative iv morphine PCA was used in Group III. As such, suppression of the stress response was observed similarly to these trials (14,15). Latterman et al (16) demonstrated that the glucose response was more limited in the patients receiving epidural anesthesia relative to the group undergoing general anesthesia.…”

“…The stress response can be avoided and the mediator levels can be maintained at the preoperative values by epidural anesthesia administered before surgical stimulation (14). In addition, epidural analgesia achieved by local anesthetics or opioids should also be maintained in the postoperative period to be able to reduce the stress response at the maximum level (15).…”

Natural Killer Cell Activity in Patients Undergoing Upper Abdominal Surgery: Relationship to the Endocrine Stress Response

“…It is well-documented that the cortisol and adrenaline responses to lower abdominal surgery can be blocked by neurogenic blockade extending from Ss to Th4 (18,19,20). The same extent of blockade, however, could not block the cortisol response to upper abdominal surgery (21).…”

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

“…al. (9) found that the increase in epinephrine, when surgical stimuli were applied, correlated with cyclic-AMP, and epidural analgesia prevented this response. Clutter et al (10) indicated that norepinephrine was not related to metabolic response, but hernodynamic and metabolic changes were caused by epinephrine administration.…”