Comparison of postoperative pain management techniques on endocrine response to surgery: A randomised controlled trial

Israel Z. Yardeni, Yehuda Shavit*, Hanna Bessler, Eduard Mayburd, Galina Grinevich, Benzion Beilin

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

The present study compared three postoperative pain management techniques in patients undergoing lower abdominal surgery: intermittent opiate regimen (IOR), patient-controlled analgesia (PCA), and patient-controlled epidural analgesia (PCEA), on cortisol and prolactin levels during the first 48 h postoperatively. Ninety-two patients scheduled for a lower abdominal surgery, were randomly assigned to one of three study groups: IOR (N = 31), PCA (N = 31), and PCEA (N = 30). Patients of the IOR group received postoperatively 50-75 mg of pethidine IM on demand. Patients of the PCA group received a loading dose of morphine (3-4 mg), followed by 1 mg bolus of morphine IV per demand. Patients of the PCEA group received 3 ml of 0.1% bupivacaine plus 2 μg/ml of fentanyl per demand, with continuous background infusion of 6 ml/h. Venous blood samples were collected preoperatively, and 24 and 48 h after surgery, and were later assayed for serum cortisol and prolactin levels. Patients of the PCEA group exhibited diminished postoperative elevation of serum cortisol levels at 24 and 48 h (24.4, 18.6 μg/dl, respectively) compared with both IOR (31.9, 21.9) and PCA (28.5, 22.3) groups. Similarly, patients of the PCEA group exhibited diminished postoperative elevation of serum prolactin level (20.7, 15.7 ng/mL) compared with PCA (24.9, 17.1) group. The present results indicate that the PCEA technique offers an advantageous treatment associated with reduced postoperative pain, and attenuated neuroendocrine response.

Original languageEnglish
Pages (from-to)239-243
Number of pages5
JournalInternational Journal of Surgery
Volume5
Issue number4
DOIs
StatePublished - Aug 2007

Funding

FundersFunder number
Ministry of Health, Jerusalem, Israel

    Keywords

    • Cortisol
    • Patient-controlled analgesia IV
    • Patient-controlled epidural analgesia
    • Pethidine
    • Postoperative pain
    • Prolactin

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