Postoperative pain management in geriatric patients after cholecystectomy and studies of glycemia and cortisol levels

Abstract

OBJECTIVE: The purpose of the study was to follow up the cortisol levels in relation to the postoperative pain intensity, its levels after treatment with opiate and non-opiate analgesics, and to monitor the relationship between the blood glucose and cortisol levels. Another goal was to optimize the postoperative analgesia of geriatric patients with the known combinations of analgesics. METHODS: The cohort comprised 28 geriatric patients undergoing laparoscopic cholecystectomy. The patients were divided according to the intensity of postoperative pain into the groups with opiate and nonopiate analgesia. Furthermore, they were divided according to their physical condition (ASA classifi cation) into two groups, ASA 2 and ASA 3. We evaluated three values of blood glucose levels, on the day before surgery, on the operative and the fi rst postoperative days and those of cortisol on the day of surgery. RESULTS: The patients had the blood glucose levels without signifi cant deviation during the three days of measurements. The cortisol levels increased with the intensity of postoperative pain. High levels of cortisol were observed not only in the patients, who experienced acute pain after non-optimal postoperative analgesia, but also in those treated with strong opiates in the immediate postoperative period. The patients with mild pain intensity, treated with a combination of non-opiate analgesics, had the lowest values. The role of the patient's gender in both blood glucose and cortisol levels was not observed. CONCLUSION: The cortisol levels have not corresponded so much with the assessment of acute postoperative pain as with the stress that was evoked in the patient due to hospitalization and fear of surgery. It is crucial to eliminate as much as possible all the stressors that can affect the cortisol levels and thus the blood glucose levels (Fig. 6, Ref. 25).

Salivary cortisol as a biomarker of stress in surgical patients

“…Albumin binds some 10-15% of cortisol with low affinity (21). In general, cortisol level increases with the pain intensity (18). Serum cortisol values increase within 15 minutes after acute stress, but decreases to basal levels as soon as the balance is re-established (22).…”

“…It is a catabolic hormone released from the adrenal gland cortex in response to physical and psychical stress [8] [16] . The major role of cortisol is to mobilize the body under stress conditions, mainly through its effects on energy and metabolism [18] [19] [20] . It is well established that 3–10% of total circulating cortisol is free (unbound), whereas the majority of the remaining cortisol shows high affinity of binding to cortisol-binding globulin.…”