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September 1, 1977British journal of surgery

Inhibition of plasma cyclic AMP, glucose and cortisol response to surgery by epidural analgesia

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Why the study?

Does epidural analgesia reduce the plasma cyclic AMP, glucose, and cortisol response to surgery in patients undergoing hysterectomy compared to general anaesthesia alone?

Population

Patients undergoing hysterectomy

Comparison

Epidural analgesia alone or general anaesthesia… vs General anaesthesia alone

Design

Cohort

Authors

SMS. Nistrup MadsenFrederiksberg HospitalMBMogens R. BrandtRigshospitaletAEA. EngquistFrederiksberg Hospital

Discussion

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Implication

Epidural analgesia may blunt surgical stress responses; hypothesis-generating for randomized trials on perioperative outcomes.

Key Points

  • To determine whether blocking afferent neural impulses with epidural analgesia suppresses the metabolic and endocrine stress responses induced by surgical trauma.
  • Measured plasma cyclic AMP, glucose, and cortisol levels across three groups of patients undergoing hysterectomy.
  • Evaluated three anaesthetic regimens: general anaesthesia alone, general anaesthesia combined with epidural analgesia (T4-6 to S5), and epidural analgesia alone (T4 to S5).
  • General anaesthesia alone elicited significant surgical elevations in plasma cyclic AMP, glucose, and cortisol.
  • Combined general and epidural analgesia abolished the cyclic AMP elevation and significantly reduced the increases in glucose and cortisol.
  • Epidural analgesia alone completely blocked the surgical surges in cyclic AMP, glucose, and cortisol.

Structured PICO

Does epidural analgesia reduce the plasma cyclic AMP, glucose, and cortisol response to surgery in patients undergoing hysterectomy compared to general anaesthesia alone?

P
Population
Patients undergoing hysterectomy
I
Intervention
Epidural analgesia alone (extending from T4 to S5) or general anaesthesia combined with epidural analgesia (extending from T4-6 to S5)
C
Comparator
General anaesthesia alone
O
Outcome
Plasma levels of cyclic AMP, glucose, and cortisolsurrogate

Epidural analgesia effectively blocks the catabolic stress response (rise in cAMP, glucose, and cortisol) to surgical trauma during hysterectomy.

Cite This Study

Madsen et al. (1977) studied this question.

synapsesocial.com/papers/6a76b8152e130d02afec2618https://doi.org/10.1002/bjs.1800640918
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Also Consider

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

  1. 1CORTISOL BINDING CAPACITY IN PLASMA DURING ANAESTHESIA AND SURGERY1974 · 59 citations
  2. 2The Blocking Effect of Epidural Analgesia on the Adrenocortical and Hyperglycemic Responses to Surgery1977 · 244 citations
  3. 3Effect of surgical trauma on plasma concentrations of cyclic AMP and cortisol1975 · 22 citations
  4. 4A SIMPLE COMPETITIVE PROTEIN-BINDING ASSAY FOR ADENOSINE-3′,5′-MONOPHOSPHATE IN PLASMA AND URINE1976 · 41 citations
  5. 5Pancreatic Alpha-Cell Function in Trauma1974 · 71 citations