[Operative stress and neuroendocrine changes: influence of anxiety, pain, and drugs]

In this study we took into consideration the neuroendocrine alterations caused by surgical stress, studying the cortisol and prolactin's course in plasma, during the period between preanesthesia and the morning after operation. Our research was particularly interested in identifying the influence of anxiety, pain and drugs. At this purpose, twenty-four patients (ASA 1-2) submitted to abdominal surgery, were subdivided in to two groups of twelve members each. In the first (group G) a general inhalising anesthesia with analgesic component was performed; in the second (group B) a selective peridural anesthesia associated with slight general anesthesia, the so-called blended anesthesia. The interpretation of the results showed an action particularly on prolactin, and of pain on cortisol. Thus, a proper use of anesthetic drugs, even if some of them have sure stimulating properties, is useful to reduce the hormonal response. Therefore as good is the control of anxiety and pain, so good is the hormonal metabolic reaction to surgical stress. If the measures to reduce anxiety are limited to a suitable preanesthesia (possibly combined with psychological preparation), on pain, on the contrary, it is possible to act with suitable technology, first of all by locoregional anesthesia. It is, however, important to underline that the best therapy of pain is its prevention.