The Effect of General Anesthesia and Thoracic Epidural Analgesia on Stress Response and Homocysteine Levels in Major Upper Abdominal Surgery: A Prospective Randomised Study

Objective: To examine the effect of general anesthesia and epidural analgesia on hemodynamic parameters, acute phase reactant, serum albumin and homocysteine levels, in elective major abdominal surgery. Material and Methods: 60 ASA I-II cases scheduled for upper abdominal surgery were divided into two groups, general anesthesia (GA) and general anesthesia+epidural analgesia (GA+EA). In the GA+EA group a 10 ml bolus of 0.1% bupivacaine was administered through a T6-T7 or T7-T8 epidural catheter. Both groups received general anesthesia of i.v. 1 mg/kg lidocaine, 2 mg/kg propofol and 0.6 mg/kg rocuronium. Maintenance anesthesia was established with 1.5% sevoflurane in 50% N2O and 50% O2. N2O was not given in the group receiving GA+EA. Plasma Stress Hormone Levels were investigated preoperatively, at the end of surgery and 8 and 24 h postoperatively. Results: Demographic data and C-reaktif protein (CRP), Erythrocyte Sedimentation Rate (ESR), prealbumin, neutrophil and cortisol counts did not differ significantly between the groups. Glucose at the end of surgery (p=0.030) and albumin at the 24th h postoperatively (p=0.031) were higher in the GA+EA group. In the GA group, homocysteine levels at the end of surgery were higher than those in the GA+EA group (P=0.049). Conclusion: We conclude that EA establishes better hemodynamics in major abdominal surgery, but has a limited effect on hormonal, metabolic and inflammatory response. We think that epidural anesthesia and analgesia may represent alternative techniques in patients with homocystinuria or hyperhomocysteinemia and that a nitrogen protoxide-related increase occurs in homocysteine levels.