General anaesthesia combined with epidural anaesthesia affected platelet responses to major abdominal surgery only to a minor extent compared to general anaesthesia alone.
RCT (n=16)
Randomized
Does general anaesthesia combined with epidural anaesthesia reduce platelet activation and stress response compared to general anaesthesia alone in healthy patients undergoing elective upper abdominal surgery?
Combining epidural with general anaesthesia during major abdominal surgery does not significantly alter platelet activation or release products, though it attenuates the haemodynamic stress response.
Platelets are activated in surgery releasing vasoactive substances such as serotonin and thromboxane. Platelets become temporarily hypoaggregable during surgery followed by a postoperative hyperaggregability. Local anaesthetics are known to inhibit platelet function but earlier reports are conflicting. In order to study the impact of the combined use of general and regional anaesthesia on platelet function during major surgery 16 otherwise healthy patients were randomised to either general anaesthesia (GA) (n = 8) or GA combined with epidural anaesthesia (GA+EPI) (n = 8) for elective upper abdominal surgery. Cyclic 3',5' adenosine monophosphate, plasma glucose, plasma cortisol and the rate pressure product (RPP) were markers of the stress response. ADP-induced platelet aggregation and the release products beta-thromboglobulin, serotonin and thromboxane 2 were measured in plasma before and during as well as for 3 days after surgery. A marked stress response was noted in both groups and epidural anaesthesia (EPI) only reduced the rate pressure product (RPP). Platelet aggregation was reduced during surgery, a little more so in the GA+EPI group. Postoperatively both groups showed significant hyperaggregability. The release products were not significantly influenced by regional anaesthesia. In conclusion epidural as combined with general anaesthesia affects platelet responses to major abdominal surgery only to a minor extent, although it may attenuate the haemodynamic response.
Næsh et al. (Tue,) conducted a rct in Elective upper abdominal surgery (n=16). General anaesthesia combined with epidural anaesthesia (GA+EPI) vs. General anaesthesia (GA) was evaluated on Platelet aggregation, release products (beta-thromboglobulin, serotonin, thromboxane 2), and stress response markers. General anaesthesia combined with epidural anaesthesia affected platelet responses to major abdominal surgery only to a minor extent compared to general anaesthesia alone.