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[Anesthesia procedure and postoperative ADH secretion].

B von Bormann, B Weidler, R Dennhardt

    Der Anaesthesist
    |April 1, 1983
    PubMed
    Summary

    This study found that epidural analgesia combined with neuroleptanalgesia significantly reduced antidiuretic hormone (ADH) levels during surgery compared to systemic pain management. Epidural opiate therapy also led to less pronounced vasopressin secretion postoperatively.

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    Area of Science:

    • Anesthesiology
    • Endocrinology
    • Pain Management

    Background:

    • Major abdominal and thoracic surgeries present significant physiological stress.
    • Effective pain management is crucial for patient recovery and hormonal balance.
    • Antidiuretic hormone (vasopressin) levels can be altered by surgical stress and anesthetic techniques.

    Purpose of the Study:

    • To investigate the impact of different anesthetic and pain management strategies on plasma vasopressin levels in surgical patients.
    • To compare the effects of neuroleptanalgesia versus neuroleptanalgesia with epidural analgesia.
    • To evaluate the influence of epidural versus systemic opioid administration on vasopressin secretion.

    Main Methods:

    • 44 patients undergoing major abdominal/thoracic surgery were divided into four groups.

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  • Plasma vasopressin levels were measured preoperatively, intraoperatively, and five days postoperatively.
  • Groups received either neuroleptanalgesia (NLA) alone or NLA combined with epidural analgesia (bupivacaine 0.5%).
  • Postoperative pain was managed with epidural fentanyl or systemic piritramide.

    • Main Results:

    • Patients under NLA alone showed a marked increase in ADH levels during surgery.
    • Patients receiving NLA plus epidural analgesia exhibited only a slight intraoperative increase in ADH.
    • Postoperative vasopressin secretion was significantly lower in patients receiving epidural opiate therapy compared to systemic therapy.

    Conclusions:

    • Combining epidural analgesia with neuroleptanalgesia attenuates the intraoperative increase in vasopressin secretion.
    • Epidural opioid administration is associated with reduced vasopressin secretion compared to systemic opioids during the postoperative period.
    • These findings suggest that regional anesthesia techniques can modulate neuroendocrine stress responses during major surgery.