Epidural analgesia attenuates the systemic stress response to upper abdominal surgery: a randomized trial

The effects of combined general anaesthesia and epidural analgesia in vario us endocrine and metabolic parameters were studied before, during, at the e nd, and 72 h after upper abdominal surgery, in an effort to further elucida te the role of epidural analgesia in the endocrine and metabolic response. 50 patients were randomly assigned into groups A and B, which received gene ral anaesthesia alone and combined general anaesthesia and epidural analges ia, respectively. The effects of surgical stress in the plasma concentratio n of ACTH (P <0.001), cortisol (P <0.01), aldosterone (P <0.05), FFA (P <0. 05) and glucose (P <0.01) were significantly less pronounced in the group o f patients who received combined general anaesthesia and epidural analgesia . However, there were no significant differences between the two groups in regard with plasma TSH, T3, T4, glucagon or Na+ concentration. These result s indicate that the combination of general anaesthesia and epidural analges ia attenuate, but does not inhibit, the endocrine and metabolic response to upper abdominal surgery.