Sa. Bew et al., Epidural analgesia and arterial reconstructive surgery to the leg: effectson fibrinolysis and platelet degranulation, BR J ANAEST, 86(2), 2001, pp. 230-235
Citations number
30
Categorie Soggetti
Aneshtesia & Intensive Care","Medical Research Diagnosis & Treatment
It has been suggested that the incidence of early graft occlusion after art
erial reconstructive surgery to the leg may be decreased by epidural analge
sia. This effect may be mediated by the suppression of the usual cortisol r
esponse to surgery, which results in increased circulating plasminogen acti
vator inhibitor-1 with consequent adverse effects on fibrinolysis. To inves
tigate this and other potential mechanisms, 30 patients undergoing arterial
reconstructive surgery to the leg were randomized to receive either genera
l anaesthesia or general anaesthesia plus epidural analgesia. Post-operativ
e analgesia was provided by morphine infusion or epidural analgesia, respec
tively. Blood samples were collected at 0, 2, 4, 6, 12 and 24 h, and 2, 3 a
nd 5 days and analysed for cortisol, plasminogen activator inhibitor-1 anti
gen, interleukin-6 and beta thromboglobulin. The incidence of graft-related
and systemic complications was recorded for 30 days. Only one patient deve
loped early graft occlusion that required embolectomy and eventually amputa
tion. There were no significant changes from control values in either group
of patients in circulating cortisol, plasminogen activator inhibitor-1 and
beta thrombogobulin (a marker for platelet degranulation). Interleukin-6 v
alues increased significantly in both groups after 4 h and remained elevate
d until day 3. There were no significant differences between the groups in
any variable measured. We conclude that any effect of epidural analgesia on
early graft patency is unlikely to be mediated by fibrinolysis or platetle
t degranulation.