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Effect of lumbar epidural anaesthesia on plasma cortisol levels in children
1Department D'Anesthesie Reanimation, Hopital Saint Vincent de Paul, Paris, France.
Insights
Epidural anesthesia with bupivacaine significantly reduced the cortisol stress response in children undergoing surgery. This approach maintained normal cortisol levels post-operation, unlike traditional pain management.
Area of Science:
- Pediatric Anesthesiology
- Endocrinology
- Surgical Stress Response
Background:
- Surgical procedures induce a significant endocrine stress response in children, primarily mediated by cortisol.
- Effective pain management is crucial for mitigating this stress response and improving patient outcomes.
Purpose of the Study:
- To compare the cortisol response to surgery in children receiving general anesthesia versus those receiving combined epidural and general anesthesia.
- To evaluate the efficacy of epidural bupivacaine in blunting the endocrine stress response in pediatric patients.
Main Methods:
- Two groups of children (1-8 years) were studied: a control group (general anesthesia, non-narcotic analgesics) and an epidural group (lumbar epidural anesthesia with bupivacaine + light general anesthesia).
- Cortisol levels were measured pre-surgery and at 0, 3, 6, 12, and 24 hours post-surgery.
- Statistical analysis compared cortisol levels between the two groups.
Main Results:
- The control group showed significant cortisol increases at 0, 3, and 6 hours post-surgery.
- The epidural group exhibited a significant decrease in cortisol at 0 hours and an increase at 12 hours, with all values remaining within the normal range.
- Mean cortisol levels at 0 and 24 hours were significantly lower in the epidural group compared to the control group.
Conclusions:
- Minimal doses of epidural bupivacaine effectively reduce the endocrine stress response to surgery in children.
- This approach may be particularly beneficial for high-risk pediatric patients with poor nutritional status.
- Epidural anesthesia offers a prolonged blunting effect on the surgical stress response compared to non-narcotic analgesics alone.
Abstract:
The cortisol response to surgery was studied in two groups of children one to eight years old during the first 24 hours after lower abdominal or peripheral surgery. The children were randomly allocated to a control (C) group (n = 6) or an epidural (E) group (n = 7). In Group C, surgery was performed under general anaesthesia and postoperative pain relief was achieved by using non-narcotic analgesics only. In Group E, lumbar epidural anaesthesia was combined with light general anaesthesia and postoperative pain relief was achieved by intermittent doses of bupivacaine administered through an epidural catheter. Cortisol levels were assessed before surgery (C), at the end of surgery (H0), at the 3rd, 6th, 12th and 24th postoperative hours (H3, H6, H12, H24). In Group C, cortisol levels increased significantly at H0, H3 and H6, whereas in Group E, a significant decrease was observed at H0 and a significant increase at H12. Mean cortisol values at H0 and H24 were significantly lower in Group E, when compared with those measured in Group C. In Group E, all postoperative cortisol values remained within the normal range, despite the low level of sensory blockade achieved. This suggests that minimal doses of epidural bupivacaine are effective in decreasing the endocrine stress response to surgery in children. This could be of clinical relevance in high-risk children with poor nutritional status. In Group C, the cortisol response remained altered for a longer period of time.