Key result
Patient-controlled epidural analgesia reduces 24-hour postoperative serum cortisol by ~24% versus intermittent opiates.
Why the study?
The comparative effects of different postoperative pain management techniques on endocrine response after lower abdominal surgery were unclear.
Does patient-controlled epidural analgesia reduce postoperative endocrine response compared to intermittent opiate regimen or patient-controlled analgesia in patients undergoing lower abdominal surgery?
RCT (n=92)
Does patient-controlled epidural analgesia reduce postoperative endocrine response compared to intermittent opiate regimen or patient-controlled analgesia in patients undergoing lower abdominal surgery?
Patient-controlled epidural analgesia attenuates the neuroendocrine stress response to lower abdominal surgery compared to systemic opiate regimens.
Answers are grounded in this paper and cite their sources.
Supports PCEA to blunt neuroendocrine stress after lower abdominal surgery; extends RCT evidence on regional analgesia beyond analgesia alone.
The present study compared three postoperative pain management techniques in patients undergoing lower abdominal surgery: intermittent opiate regimen (IOR), patient-controlled analgesia (PCA), and patient-controlled epidural analgesia (PCEA), on cortisol and prolactin levels during the first 48 h postoperatively. Ninety-two patients scheduled for a lower abdominal surgery, were randomly assigned to one of three study groups: IOR (N=31), PCA (N=31), and PCEA (N=30). Patients of the IOR group received postoperatively 50-75 mg of pethidine IM on demand. Patients of the PCA group received a loading dose of morphine (3-4 mg), followed by 1mg bolus of morphine IV per demand. Patients of the PCEA group received 3 ml of 0.1% bupivacaine plus 2 microg/ml of fentanyl per demand, with continuous background infusion of 6ml/h. Venous blood samples were collected preoperatively, and 24 and 48 h after surgery, and were later assayed for serum cortisol and prolactin levels. Patients of the PCEA group exhibited diminished postoperative elevation of serum cortisol levels at 24 and 48 h (24.4, 18.6 microg/dl, respectively) compared with both IOR (31.9, 21.9) and PCA (28.5, 22.3) groups. Similarly, patients of the PCEA group exhibited diminished postoperative elevation of serum prolactin level (20.7, 15.7 ng/mL) compared with PCA (24.9, 17.1) group. The present results indicate that the PCEA technique offers an advantageous treatment associated with reduced postoperative pain, and attenuated neuroendocrine response.
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Yardeni et al. (2006) conducted an RCT in lower abdominal surgery (n=92). Patient-controlled epidural analgesia (PCEA) vs. Intermittent opiate regimen (IOR) and patient-controlled analgesia (PCA) was evaluated on Serum cortisol levels at 24 hours (microg/dl). Patient-controlled epidural analgesia diminished postoperative elevation of serum cortisol at 24 hours (24.4 microg/dl) compared with intermittent opiate regimen (31.9) and PCA (28.5).
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