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Effect of extradural analgesia on stress responses to abdominal surgery in infants
A R Wolf1, R L Eyres, P C Laussen
1Royal Hospital for Sick Children, Yorkhill, Glasgow, Australia.
Insights
Extradural bupivacaine provided better pain relief and stress response management than systemic opioids for children undergoing abdominal surgery. This anesthesia technique led to lower levels of stress hormones and glucose post-operation.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pharmacology
Background:
- Effective perioperative pain management is crucial in pediatric surgery.
- General anesthesia supplemented with opioids or regional anesthesia techniques are common.
- Understanding the neuroendocrine stress response to different anesthetic techniques is important for optimizing patient outcomes.
Purpose of the Study:
- To compare the effects of extradural bupivacaine versus systemic opioids on the neuroendocrine stress response in children undergoing abdominal surgery.
- To evaluate the analgesic efficacy and safety of both anesthetic techniques.
Main Methods:
- A study involving 40 children under 4 years old undergoing elective abdominal surgery.
- Comparison of general anesthesia supplemented with either systemic opioids or extradural bupivacaine.
- Measurement of plasma concentrations of adrenaline, noradrenaline, glucose, ACTH, and cortisol at multiple time points.
- Monitoring of plasma bupivacaine concentrations in the extradural group.
Main Results:
- Both techniques provided acceptable analgesia.
- The opioid group showed significantly greater perioperative increases in adrenaline, glucose, and ACTH.
- Noradrenaline concentrations decreased below baseline in the extradural group and were significantly lower than in the opioid group.
- Cortisol responses were similar between groups despite differing ACTH levels.
- Most measured parameters returned to baseline within 24 hours.
- Plasma bupivacaine levels remained within safe limits, though some increases were noted during postoperative infusion.
Conclusions:
- Extradural bupivacaine is associated with a blunted stress response compared to systemic opioids in pediatric abdominal surgery.
- This suggests extradural anesthesia may offer advantages in managing the perioperative stress response in this population.
- Further research may explore long-term benefits and optimal dosing strategies for extradural analgesia in pediatric surgical patients.
Abstract:
We studied 40 children younger than 4 yr having elective abdominal surgery under general anaesthesia supplemented with either systemic opioids or extradural bupivacaine. Venous blood samples were obtained before tracheal intubation to measure baseline concentrations of adrenaline, noradrenaline, glucose, ACTH and cortisol. Additional samples were obtained 45 min after the start of surgery, at the end of surgery, 1 h and 24 h after the end of surgery. Plasma concentrations of bupivacaine were measured also in the extradural group at each sampling time. Both techniques provided acceptable analgesia, but the perioperative increases in adrenaline, glucose and ACTH were significantly greater in the opioid group. Noradrenaline concentrations decreased to less than baseline values in the extradural group and were significantly less than in the opioid group. The perioperative increase in cortisol was similar in the two groups, despite the differences in ACTH responses. Most responses returned to the baseline values within 24 h. Plasma bupivacaine concentrations remained within safe limits during the study, but systemic concentrations increased in some of the patients during postoperative infusion with 0.125% bupivacaine.