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February 1, 1980Acta Anaesthesiologica Scandinavica

Influence of Epidural Analgesia on the Catecholamine and Cyclic AMP Responses to Surgery

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Why the study?

Does the addition of epidural analgesia to general anesthesia reduce the catecholamine and cyclic AMP responses in patients undergoing surgery?

Population

18 patients subjected to surgery of moderate or minor extent (including hysterectomy)

Comparison

Epidural analgesia added to enflurane anesthesia vs Enflurane anesthesia alone

Design

Other

Follow-up

During and after surgery

Authors

AEA. EngquistFrederiksberg HospitalFFF. Fog‐MøllerSankt Hans HospitalCCC. ChristiansenUniversity of Copenhagen

Discussion

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Implication

May blunt surgical adrenaline response; hypothesis-generating for neurogenic catecholamine control and should not change practice.

Key Points

  • To determine how neurogenic blockade via epidural analgesia influences circulating levels of adrenaline, noradrenaline, and cyclic AMP during surgical trauma.
  • Assessed 18 patients undergoing minor or moderate surgical procedures (such as hysterectomy) under enflurane anesthesia with or without concurrent epidural analgesia.
  • Measured serial plasma concentrations of adrenaline, noradrenaline, and cyclic AMP during intraoperative and postoperative periods.
  • Epidural analgesia successfully blocked the intraoperative surge in plasma adrenaline seen during general anesthesia, bringing levels down to those observed during minor surgical stress.
  • Noradrenaline concentrations showed no direct correlation with surgical trauma severity, although epidural blockade was associated with a postoperative noradrenaline increase independent of hemodynamic changes.
  • Intraoperative elevations in plasma cyclic AMP were driven by adrenaline-stimulated beta-adrenergic pathway activation rather than resting basal tone.

Structured PICO

Does the addition of epidural analgesia to general anesthesia reduce the catecholamine and cyclic AMP responses in patients undergoing surgery?

P
Population
18 patients subjected to surgery of moderate or minor extent (including hysterectomy)
I
Intervention
Epidural analgesia added to enflurane anesthesia
C
Comparator
Enflurane anesthesia alone
O
Outcome
Plasma concentrations of adrenaline, noradrenaline, and cyclic AMPsurrogate

Epidural analgesia blocks the adrenaline response to surgical stress, demonstrating that this response is primarily driven by neurogenic stimuli.

Cite This Study

Engquist et al. (1980) studied this question.

synapsesocial.com/papers/6a76b8152e130d02afec2611https://doi.org/10.1111/j.1399-6576.1980.tb01497.x
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Mechanism of Plasma Catecholamine Increases During Surgical Stress in Man1977 · 285 citations
  2. 2The Blocking Effect of Epidural Analgesia on the Adrenocortical and Hyperglycemic Responses to Surgery1977 · 244 citations
  3. 3Cyclic AMP, adrenaline and noradrenaline in plasma during surgery1978 · 66 citations
  4. 4Inhibition of plasma cyclic AMP, glucose and cortisol response to surgery by epidural analgesia1977 · 47 citations
  5. 5FLUORIMETRIC DETERMINATION OF FREE PLASMA 11-HYDROXYCORTICOSTEROIDS IN MAN1960 · 249 citations