The Effects of General Anesthesia Combined with Epidural Anesthesia Using Fentanyl and Bupivaine on Serum Prolactin , Cortisol and Blood Glucose Level

Cho, Hun; Chae, Byung Kook; Chang, Seong Ho

Abstract

Perioperative surgical stress makes various metabolic and endocrinologic changes that may influence the postoperative outcome. These changes, so-called, "surgical stress responses" ar hyperglycemia, lipolysis, negative nitrogen balance due to proteolysis, and changes in the hormonal secretion, e.g. increased release of ACTH, prolactin, cortisol, catecholamine, and so on. To prevent these stress responses, many studies reported some kinds of effective methods. In these study we used general anesthesia combined with epidural blockade with local anesthetic(bupivacaine) and narcotic(fentanyl) mixture via epidural catheter for the total abdominal hysterectomy and the postoperative pain control(group II). We measured serum prolactin and cortisol concentrations by time-resolved fluoroimmunoassay and glucose concentrations by routine glucose oxidase method and scored the degree of postoperative pain and compared the results with those of group I, given general anesthesia during surgery and nalbuphine intramuscular injection for postoperative pain control. The results were as follows. 1) Serum prolactin concentrations were increased during the operation in both groups. 2) Serum cortisol concentrations were increased during and after the operation in both groups but were normalized sooner in group II. 3) Serum glucose concentrations were increased during and after the operation but were normalized sooner in group IL 4) The three measurements showed significant differences between the two groups during and on the first postoperative day. 5) The pain scores were significantly lower in group II untill the third postoperative day. According to the results, we concluded that serum prolactin concentration could be as much valuable index to surgical stress response as serum cortisol concentration and that the method of epidural blockade combined with general anesthesia for the surgery and postoperative pain control via epidural route could prevent or alleviate the stress response more effectively.