Document Detail


Sympatho-adrenal and pituitary hormone responses during and immediately after thoracic surgery--modulation by four different pain treatments.
MedLine Citation:
PMID:  3434168     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Four different pain treatments (single intercostal block with bupivacaine, repeated intercostal block, epidural morphine and epidural bupivacaine infusions) were compared in 39 patients subjected to lung surgery under general anaesthesia. The patients' own estimate of the postoperative pain was not significantly different between the groups, but the epidurally treated patients required fewer doses of supplementary analgesic than those given just a single dose of intercostal bupivacaine. Bupivacaine levels in blood were below the toxic range in all groups. The concentration of antidiuretic hormone in blood was increased early during the operation, and had only partly returned to normal on the first postoperative morning. Growth hormone in plasma was increased only at the end of the operation. Catecholamine levels in blood increased gradually, reaching their peak postoperatively. There were only slight differences between the groups in these posterior and anterior pituitary and sympatho-adrenal responses to surgical stress. Thus, neither repeated intercostal blockade nor epidural administration of morphine or bupivacaine could prevent the endocrine responses to thoracic surgery, in spite of significant, albeit incomplete, pain relief. This was probably caused in part by residual pain, and also by poor access of the extradural medications to the autonomic afferent pathways mediating nociceptive signals from thoracic organs and tissues.
Authors:
B Scheinin; M Scheinin; R Asantila; R Lindberg; O Viinamäki
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Acta anaesthesiologica Scandinavica     Volume:  31     ISSN:  0001-5172     ISO Abbreviation:  Acta Anaesthesiol Scand     Publication Date:  1987 Nov 
Date Detail:
Created Date:  1988-03-10     Completed Date:  1988-03-10     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0370270     Medline TA:  Acta Anaesthesiol Scand     Country:  DENMARK    
Other Details:
Languages:  eng     Pagination:  762-7     Citation Subset:  IM    
Affiliation:
Department of Anaesthesiology, Surgical Hospital, Helsinki University Central Hospital, Finland.
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MeSH Terms
Descriptor/Qualifier:
Aged
Anesthesia, Conduction
Anesthesia, Epidural
Bupivacaine / therapeutic use
Catecholamines / blood*
Female
Growth Hormone / blood*
Humans
Lung Neoplasms / surgery*
Male
Middle Aged
Morphine / therapeutic use
Pain Measurement
Pain, Postoperative / blood,  drug therapy*
Time Factors
Vasopressins / blood*
Chemical
Reg. No./Substance:
0/Catecholamines; 11000-17-2/Vasopressins; 2180-92-9/Bupivacaine; 57-27-2/Morphine; 9002-72-6/Growth Hormone

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