The Modifying Effect of Spinal Anaesthesia on Intra‐ and Postoperative Adrenocortical and Hyperglycaemic Response to Surgery

Abstract

Plasma cortisol and glucose were measured in 24 patients undergoing abdominal hysterectomy during spinal anaesthesia with 0.5% hyperbaric tetracaine or neurolept anaesthesia. The sensory level of analgesia to pinprick extended to at least T4 before skin incision in the spinal group. The mean sensory analgesic level regressed almost linearly, reaching the fourth lumbar segment 4 h after incision. Plasma cortisol and glucose measurements from before to 9 h after skin incision showed significant increases in both parameters during and after surgery. Plasma cortisol and glucose levels were significantly lower during and immediately after surgery in the spinal group, but later postoperatively the mean levels were similar in the two groups. The increase in plasma cortisol 1 h after skin incision in the spinal group correlated to the segmental level of analgesia at that time (r = 0.77, P less than 0.01) and a similar correlation was found with regard to plasma glucose changes (r = 0.60, P less than 0.05). The regression lines showed that maintenance of a sensory analgesic level about the fourth thoracic segment prevented the adrenocortical and hyperglycaemic response to surgery. These findings are in accordance with the anatomical assumption that the upper segmental level of visceral afferent input to the spinal cord is about the fourth thoracic segment. Our results further demonstrate that the inhibitory effect of spinal anaesthesia on the stress response to surgery is transient, and correlates to the regression of sensory analgesia.

Comparative Study of Intra Operative Blood Sugar Level in Spinal Anesthesia and General Anesthesia in Patients undergoing Elective Surgery

“…SA inhibited these afferent nerves and thus the intra opera ve and post opera ve increase in epinephrine and norepinephrine were not observed. The similar result was also observed in the previous study where the SA inhibited the stress response to surgery by blun ng adrenocor cophic hormone, norepinephrine, growth hormone and cor sol response intra opera vely and in the 12 immediate postopera ve period.…”

“…For sample size calcula on, we considered 5% as acceptable level of significance (Type I error) and 80% as power of study. On the basis of the study 12 conducted by Moller I W, Hjortso E, Krantz T, et al the effect size was considered 0.6 and considering 10% as drop out sample size was calculated to be 30 in each group. Group 1: Spinal anesthesia including 30 pa ents.…”

Glucocorticoid regulation of the inflammatory response to injury

“…All of these early cytokine responses are necessary to achieve a maximal HPA response to LPS (17). During lower extremity or lower abdominal surgical trauma, for example, epidural block of spinal afferent signals is associated with a minimal circulating cytokine response since neural blockade prevents or markedly limits HPA activation in these settings (18)(19)(20) although it fails to limit HPA activation during other types of surgery (upper abdominal or thoracic) that are associated with substantial cytokine release (18,21). During lower extremity or lower abdominal surgical trauma, for example, epidural block of spinal afferent signals is associated with a minimal circulating cytokine response since neural blockade prevents or markedly limits HPA activation in these settings (18)(19)(20) although it fails to limit HPA activation during other types of surgery (upper abdominal or thoracic) that are associated with substantial cytokine release (18,21).…”

“…Afferent neural input from a site of injury can also activate the HPA axis. During lower extremity or lower abdominal surgical trauma, for example, epidural block of spinal afferent signals is associated with a minimal circulating cytokine response since neural blockade prevents or markedly limits HPA activation in these settings (18)(19)(20) although it fails to limit HPA activation during other types of surgery (upper abdominal or thoracic) that are associated with substantial cytokine release (18,21). It is now clear that HPA and sympathoadrenal activation occur at multiple levels in the brain and in the periphery and that there is considerable cross-talk and feedback occurring between these two systems at every level creating not only complexity but redundancy in processes that act to stimulate and/or suppress inflammation.…”

Anaesthesia and Stress Response to Surgery

“…During lower extremity or lower abdominal surgical trauma, for example, epidural block of spinal afferent signals, is associated with a minimal circulating cytokine response since neural blockade prevents or markedly limits hypothalamicpituitary axis (HPA) activation in these settings (Moller et al, 1984;Naito et al,1992;Moore et al, 1994;Lattermann et al, 2003) However, it fails to limit HPA activation during other types of surgery (upper abdominal or thoracic) that are associated with substantial cytokine release (Naito et al, 1992;Norman and Fink, 1997) Local anaesthetics can reduce the postoperative inflammatory response in two ways: they block neural transmission at the site of tissue injury and decrease the neurogenic inflammation (Coderre et al, 1993); they also have systemic anti-inflammatory properties of their own (Hollmann and Durieux, 2000).…”