Intubation anesthesia (combined opiate analgesia) plus modified peridural anesthesia and the endocrine stress-reaction
Von Bormann, B.; Weidler, B.; Kling, D.; Sturm, G.; Scheld, H.H.; Hempelmann, G.
Regional-Anaesthesie 6(3): 52-57
1983
ISSN/ISBN: 0171-1946 PMID: 6612016 Document Number: 213625
Patients (37) scheduled for major surgery (vascular, abdominal and thoracic) were divided prospectively into 3 groups. Anesthetic management for all patients included general anesthesia (combined opiate-analgesia)in combination with epidural analgesia (EDA). A different kind of EDA was performed for the 3 groups by using the following agents: group A (n = 12) bupivacaine 0.5%; group B (n = 14) etidocaine 1.0%; and group C (n = 11) bupivacaine 0.5% plus fentanyl. Blood samples for analyzing antidiuretic hormone [ADH], Na, K and plasma-osmolality were obtained preoperatively (twice), intraoperatively (11 times) and postoperatively (3-times). Artificial ventilation, fluid therapy including substitution of blood-loss were standardized for avoiding an additive influence on ADH-secretion. Serum electrolytes (Na and K) as well as plasma-osmolality remained within normal range during the whole investigation period. Preoperatively no differences in ADH-secretion between the 3 groups were noticed; mean-values stayed within normal range. After starting the surgical procedure significant differences became obvious: ADH-levels in group A (bupivacaine 0.5%) did not increase during the operation; in group B (etidocaine 1.0%) there was a tremendous increase in ADH during the whole surgical intervention. ADH-levels in group C (bupivacaine 0.5% + fentanyl) were above normal range and about twice as high as those of group A. Postoperative values demonstrated a close correlation between ADH-levels and the onset of pain in all groups. While ADH-secretion in group A and C was similar within the postoperative interval, ADH-levels in group B stayed significantly above those of the other 2 groups. Significant differences are indicated between the analgesic effect of modified EDA in addition to general anesthesia. Under the view of endocrine-metabolic stress-response, EDA with bupivacaine seems to be the better method for stress-attenuation.