Local Analgesia Prevents the Cortisol and Glycaemic Responses to Cataract Surgery

Abstract

We studied the metabolic and hormonal responses to cataract surgery in 18 elderly patients, allocated randomly to receive either general anaesthesia or local analgesia by means of a retrobulbar block. Local analgesia prevented the increases in circulating cortisol and glucose concentrations found in those patients who received general anaesthesia. The results show that complete afferent sensory block of the operative site inhibited endocrine and metabolic responses to ophthalmic surgery.

A preoperative retrobulbar block in patients undergoing scleral buckling reduces pain, endogenous stress response, and improves vigilance

“…In ophthalmology (cataract surgery), a retrobulbar block prevented the increases in circulating cortisol and glucose concentrations, which were found in those patients who received general anesthesia. 6 In accordance with these data, cortisol levels in our study declined after retrobulbar block as compared with baseline and remained at this low level until 60 minutes postoperatively. In addition, the cortisol levels in the bupivacaine group were significantly lower than in the saline group 50 minutes after beginning surgery and 60 minutes after completion of surgery.…”

“…At the same time points, 10 mL of blood were withdrawn for measurement of glucose and cortisol levels to evaluate the efficacy of retrobulbar block in eliminating humoral response. [6][7][8] The time from the injection of propofol until the completion of surgery (ϭ closure of the conjunctiva) was defined as duration of anesthesia, the time from the incision until the closure of the conjunctiva as duration of surgery. Requirements of alfentanil and propofol were documented between the start of anesthesia and the retrobulbar injection as well as from the retrobulbar injection until the completion of surgery.…”

“…In any case, an insufficient pain stimulus is not responsible for the inadequate increase in glucose concentration, because pain during cataract surgery already increases glucose (and cortisol) concentrations. 6 In comparison, retinal detachment surgery is followed by much more intense and longer-lasting pain. 1 Plasma levels of bupivacaine do not influence endocrine and metabolic responses because even concentrations of 1 to 2 g/mL -1 did not affect cortisol and glucose concentrations.…”

Cataract surgery anaesthesia: is topical anaesthesia really better than retrobulbar?

“…As a result of the pain and the activation of the sympathetic nerve system, we would expect increases in blood pressure, heart rate frequency, and in catecholamine and cortisol levels, and decreases in white blood cell numbers (Barker et al 1990(Barker et al , 1991(Barker et al , 1993(Barker et al , 1994Sanders et al 1997).…”

Peri‐operative steroid supplementation

“…Thus an extensive T4-S5 block is necessary for pelvic surgery [100] and it has been known for over 25 years that it is very difficult in upper abdominal surgery to prevent cortisol secretion with regional anaesthesia [101]. Other operations which are amenable to complete afferent blockade are limb and eye surgery [102].…”