Effect of combined prednisolone, epidural analgesia, and indomethacin on the systemic response after colonic surgery.

Twenty patients undergoing colonic resection were randomized to either conventional postoperative pain treatment with morphine chloride and acetaminophen (group 1, n = 9) or methylprednisolone sodium succinate 90 minutes before surgery plus intraoperative neural blockade, with a postoperative analgesic regimen with combined bupivacaine hydrochloride-morphine and indomethacin sodium for systemic effect (group 2, n = 11). Assessments of pain, pulmonary function, convalescence, and various injury factors were done several times until 8 days after surgery. Postoperative pain and hyperthermic response were eliminated in group 2. Conventional reduction in pulmonary function measures was improved in group 2, and fatigue and mobility were less pronounced. Prostaglandin E2, interleukin 6, and C-reactive protein levels increased in both groups, but significantly less in group 2. These results suggest that a combined neural and humoral blockade may more effectively inhibit the global stress response to elective surgery than previously observed with neural blockade with or without indomethacin.

[1]  B. Meyrick,et al.  Modification of pulmonary responses to endotoxemia in awake sheep by steroidal and nonsteroidal anti-inflammatory agents. , 2015, The American review of respiratory disease.

[2]  H. Kehlet,et al.  Regional anaesthesia and surgical morbidity. , 2005, The British journal of surgery.

[3]  W. Fraser,et al.  Response of serum interleukin-6 in patients undergoing elective surgery of varying severity. , 1990, Clinical science.

[4]  S. Lowry,et al.  Tumor necrosis factor in the pathophysiology of infection and sepsis. , 1990, Clinical immunology and immunopathology.

[5]  H. Kehlet,et al.  [Assessment of early postoperative convalescence by a simple scoring system]. , 1990, Ugeskrift for laeger.

[6]  D. Wilmore,et al.  Sepsis, signals, and surgical sequelae (a hypothesis). , 1990, Archives of surgery.

[7]  Torben Æ. Mogensen,et al.  Prevention of postoperative pain by balanced analgesia. , 1990, British journal of anaesthesia.

[8]  J. Mannick,et al.  Effect of low dose recombinant interleukin 2 plus indomethacin on mortality after sepsis in a murine burn model , 1990, The British journal of surgery.

[9]  L. Moldawer,et al.  The biologic characteristics of cytokines and their implication in surgical injury. , 1990, Surgery, gynecology & obstetrics.

[10]  H. Kehlet,et al.  Effect of combined prednisolone, epidural analgesia and indomethacin on pain, systemic response and convalescence after cholecystectomy. , 1990, Acta chirurgica Scandinavica.

[11]  K. Tracey,et al.  Peptide Regulatory Factors CACHECTIN/TUMOUR NECROSIS FACTOR , 1989, The Lancet.

[12]  A. O’Garra.  Interleukins and the immune system 1. , 1989, Lancet.

[13]  R. Douglas,et al.  Metabolic response to sepsis and trauma , 1989, The British journal of surgery.

[14]  A. Shenkin,et al.  Effect of nutritional status on acute phase protein response to elective surgery , 1989, The British journal of surgery.

[15]  P. Heinrich,et al.  Interleukin‐6 is the major regulator of acute phase protein synthesis in adult human hepatocytes , 1989, FEBS letters.

[16]  H. Kehlet,et al.  Regional anaesthesia and surgical morbidity , 1988, The British journal of surgery.

[17]  A. Cerami,et al.  Tumor necrosis factor and endotoxin induce similar metabolic responses in human beings. , 1988, Surgery.

[18]  D. Inthorn,et al.  Immunoprotective effects of cyclooxygenase inhibition in patients with major surgical trauma , 1988 .

[19]  P. Wall.  The prevention of postoperative pain , 1988, Pain.

[20]  H. Kehlet,et al.  Influence of combined neural blockade, H1- and H2-receptor and serotonin2-receptor blockade, indomethacin and tranexamic acid on leucocyte, temperature and acute-phase protein response to surgery. , 1988, Acta chirurgica Scandinavica.

[21]  R. Meyer,et al.  Peripheral Mechanisms of Somatic Pain , 1988, Anesthesiology.

[22]  H. Kehlet,et al.  Epidural bupivacaine and morphine plus systemic indomethacin eliminates pain but not systemic response and convalescence after cholecystectomy. , 1988, Surgery.

[23]  T. Ulich,et al.  Kinetics and mechanisms of recombinant human interleukin 1 and tumor necrosis factor-alpha-induced changes in circulating numbers of neutrophils and lymphocytes. , 1987, Journal of immunology.

[24]  P. Lansdorp,et al.  Interferon beta 2/B-cell stimulatory factor type 2 shares identity with monocyte-derived hepatocyte-stimulating factor and regulates the major acute phase protein response in liver cells. , 1987, Proceedings of the National Academy of Sciences of the United States of America.

[25]  K. Partanen,et al.  The effect of thoracic epidural analgesia on respiratory function after cholecystectomy , 1987, Acta anaesthesiologica Scandinavica.

[26]  A. Waage,et al.  ASSOCIATION BETWEEN TUMOUR NECROSIS FACTOR IN SERUM AND FATAL OUTCOME IN PATIENTS WITH MENINGOCOCCAL DISEASE , 1987, The Lancet.

[27]  B. Beutler,et al.  Cachectin: more than a tumor necrosis factor. , 1987, The New England journal of medicine.

[28]  C. Dinarello,et al.  Purified interleukin-1 (IL-1) from human monocytes stimulates acute-phase protein synthesis by rodent hepatocytes in vitro. , 1987, Immunology.

[29]  H. Colten,et al.  Cachectin/tumor necrosis factor regulates hepatic acute-phase gene expression. , 1986, The Journal of clinical investigation.

[30]  C. Dinarello,et al.  Immunoregulatory feedback between interleukin-1 and glucocorticoid hormones. , 1986, Science.

[31]  M. Wattwil,et al.  Respiratory effects of high thoracic epidural anaesthesia , 1986, Acta anaesthesiologica Scandinavica.

[32]  Eric M. Smith,et al.  Corticotropin-releasing activity of monokines. , 1985, Science.

[33]  C. McArdle,et al.  Postoperative pain and pulmonary complications: Comparison of three analgesic regimens , 1985, The British journal of surgery.

[34]  A. Kelso,et al.  Glucocorticoid inhibition of lymphokine secretion by alloreactive T lymphocyte clones. , 1984, Journal of immunology.

[35]  S. Shumway,et al.  PROSTAGLANDINS AND CELL‐MEDIATED IMMUNITY: THE ROLE OF PROSTAGLANDIN E1 IN THE INDUCTION OF HOST‐VERSUS-GRAFT AND GRAFT‐VERSUS- HOST REACTIONS IN MICE , 1984, Transplantation.

[36]  W. Marasco,et al.  Stimulus specificity of prostaglandin inhibition of rabbit polymorphonuclear leukocyte lysosomal enzyme release and superoxide anion production. , 1984, The American journal of pathology.

[37]  B. Samuelsson.  Leukotrienes: mediators of immediate hypersensitivity reactions and inflammation. , 1983, Science.

[38]  J. Rask-Madsen,et al.  Comparison of radioimmunological determinations with gas chromatography mass spectrometry dosage. A study of PGE2 and PGF2alpha in gastrointestinal fluids. , 1983, Biomedical mass spectrometry.

[39]  G. H. Clowes,et al.  Muscle proteolysis induced by a circulating peptide in patients with sepsis or trauma. , 1983, The New England journal of medicine.

[40]  T Bendix,et al.  Fatigue and cardiorespiratory function following abdominal surgery , 1982, The British journal of surgery.

[41]  J. Rask-Madsen,et al.  Prostaglandin E2 in jejunal fluids and its potential diagnostic value for selecting patients with indomethacin‐sensitive diarrhoea , 1981, European journal of clinical investigation.

[42]  D. Duval,et al.  Involvement of glucocorticoid receptors in steroid-induced inhibition of prostaglandin secretion. , 1979, The Journal of biological chemistry.

[43]  A. Fauci,et al.  Comparison of agents producing a neutrophilic leukocytosis in man. Hydrocortisone, prednisone, endotoxin, and etiocholanolone. , 1975, The Journal of clinical investigation.

[44]  E. Huskisson.  Measurement of pain. , 1974, Lancet.

[45]  P. Barie,et al.  Serum cachectin/tumor necrosis factor in critically ill patients with burns correlates with infection and mortality. , 1990, Surgery, gynecology & obstetrics.

[46]  W. Fraser,et al.  The serum interleukin 6 response to elective surgery. , 1989, Lymphokine research.

[47]  D. Hosford,et al.  The potential role of platelet-activating factor (PAF) in shock, sepsis and adult respiratory distress syndrome (ARDS). , 1989, Progress in clinical and biological research.

[48]  F. D. Sydow.  The influence of anesthesia and postoperative analgesic management of lung function. , 1989, Acta chirurgica Scandinavica. Supplementum.

[49]  C. Dinarello,et al.  New concepts on the pathogenesis of fever. , 1988, Reviews of infectious diseases.

[50]  R. Wallis,et al.  Tumor necrosis factor is the major monocyte product that increases complement receptor expression on mature human neutrophils. , 1988, Blood.

[51]  C. Uyttenhove,et al.  Interleukin‐HP1‐related hybridoma and plasmacytoma growth factors induced by lipopolysaccharide in vivo , 1987, European journal of immunology.

[52]  W. Vogt.  Anaphylatoxins: possible roles in disease. , 1986, Complement.

[53]  D. Lundberg.  The pharmacological basis of treatment with high dose corticosteroids in circulatory shock. , 1985, Acta chirurgica Scandinavica. Supplementum.

[54]  U. Haglund,et al.  Increased survival of endotoxin-injected dogs treated with methylprednisolone, naloxone, and ibuprofen. , 1984, Circulatory shock.

[55]  N. Holbrook,et al.  Physiological functions of glucocorticoids in stress and their relation to pharmacological actions. , 1984, Endocrine reviews.

[56]  M. Dukes.  Corticotrophins and corticosteroids , 1981 .