The surgical stress response: should it be prevented?

Area of Science:

• Anesthesiology
• Surgical Outcomes Research
• Physiology

Background:

• Postoperative complications (myocardial infarction, infection, thromboembolism, fatigue) are linked to the physiological
• surgical stress response.
• This response involves increased metabolic demands, hypermetabolism, and catabolism.
• Current strategies aim to mitigate detrimental aspects of this stress response to enhance patient recovery.

Purpose of the Study:

• To evaluate the effectiveness of strategies designed to suppress the surgical stress response.
• To determine if reducing nociception improves postoperative outcomes.
• To assess the potential of a
• stress-free anesthesia and surgery
• approach in clinical practice.

Main Methods:

• Review of controlled clinical trials investigating interventions to reduce the surgical stress response.
• Focus on afferent neural blockade using regional anesthesia for pain relief (nociceptive blockade).
• Analysis of data correlating nociceptive blockade with the incidence of various postoperative morbidities.

Main Results:

• Afferent neural blockade with regional anesthesia is identified as the most effective method for reducing the surgical stress response, though not optimal.
• Numerous clinical trials demonstrate that nociceptive blockade significantly reduces various aspects of postoperative morbidity.
• Findings provide strong evidence supporting the concept of stress reduction in surgery.

Conclusions:

• Targeting and suppressing the surgical stress response is a viable strategy for improving postoperative outcomes.
• Nociceptive blockade through regional anesthesia is a key component in achieving a less stressful surgical experience.
• The concept of
• stress-free anesthesia and surgery
• is a valuable framework for enhancing surgical patient care.