Influence of Extradural Morphine on the Adrenocortical and Hyperglycaemic Response to Surgery

Abstract

Plasma cortisol and glucose concentrations were measured repeatedly from before the induction of anaesthesia until 9 h after skin incision in 36 patients undergoing abdominal hysterectomy. Twelve patients received general anaesthesia (halothane), and systemic opiates for postoperative pain; a further 12 patients underwent continuous extradural analgesia with a local anaesthetic agent (bupivacaine) and in the remaining 12 patients general anaesthesia (halothane) plus extradural morphine (4mg before skin incision and an additional 4mg at skin closure) were used. Patients receiving extradural morphine or bupivacaine were free of pain. The physiological cortisol and glucose response to surgery was blocked by the extradural analgesia with bupivacaine. Extradural morphine did not modify the initial increase in plasma cortisol and glucose concentrations during surgery, but suppressed the hyperglycaemic and cortisol response following surgery when compared with the general anaesthesia group receiving systemic opiates. However, cortisol and glucose concentrations were greater after operation in patients receiving extradural morphine compared with extradural bupivacaine, suggesting that the endocrine metabolic response to surgery is predominantly released by neurogenic stimuli other than pain stimuli involving opiate receptor-dependent nociceptive pathways.

Comparison of Stress Hormone Response, Interleukin-6 and Anaesthetic Characteristics of Two Anaesthetic Techniques: Volatile Induction and Maintenance of Anaesthesia using Sevoflurane versus Total Intravenous Anaesthesia using Propofol and Remifentanil

“…Increases in cortisol and glucose levels are common features of patients with surgical stress but, typically, values rapidly return to normal. 29 Hyperglycaemia can, however, be accompanied by various adverse systemic effects, including altered immune FIGURE 1: Adrenaline, noradrenaline, cortisol, glucose and interleukin-6 concentrations (means ± SD) in total abdominal hysterectomy patients undergoing total intravenous anaesthesia (TIVA) with propofol and remifentanil or volatile induction and maintenance of anaesthesia (VIMA) with sevoflurane alone (T1, baseline; T2, intubation; T3, incision, T4, extubation; *P < 0.05, **P < 0.01 and ***P < 0.001 versus baseline; † P < 0.05, † † P < 0.01 and † † † P < 0.001 for the TIVA group versus the VIMA group. function and poorer neurological outcomes, and may be detrimental in immunocompromised or neurologically unstable patients.…”

The Role of Microbiota and Probiotics in Stress-Induced Gastrointestinal Damage

“…In addition, the importance of the neuroendocrine stress response in patients following surgical trauma is shown by the positive clinical effects of epidural analgesia in the postoperative course after major gastro-intestinal surgery [125]. Epidural analgesia, which blocks the regional innervation to the intestine and interrupts the transmission of pain from the area, attenuates the stress response, as shown by lower postoperative levels of adrenocorticotropic hormone (ACTH), cortisol, aldosterone and glucose [126,127].…”

Postoperative Pain Management and Proinflammatory Cytokines: Animal and Human Studies

“…This response is characterized by activation of the hypothalamic-pituitary-adrenal (HPA) axis, leading to elevated levels of adrenocorticotropin (ACTH) and corticosterone (CS) (Christensen et al 1982). The neuroendocrine, inflammatory, and pain responses to surgery are interrelated and mutually influence one another.…”