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Epidural ropivacaine and sufentanil and the perioperative stress response after a radical retropubic prostatectomy
Author(s) -
HONG J.Y.,
YANG S. C.,
YI J.,
KIL H. K.
Publication year - 2011
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.2010.02360.x
Subject(s) - medicine , sufentanil , ropivacaine , radical retropubic prostatectomy , prostatectomy , anesthesia , perioperative , urology , prostate , cancer
Background: The effects of an epidural opioid and a local anesthetic on the perioperative stress responses have not been fully investigated in elderly patients undergoing cancer surgery. We hypothesized that the stress response after a radical retropubic prostatectomy (RRP) would be attenuated by epidural ropivacaine and sufentanil. Methods: In this randomized, double‐blinded study, we included patients above 65 years of age who were scheduled for a RRP. In addition to general anesthesia, they received either epidural saline continuously (5 ml/h) (C group, n =20); 0.3% ropivacaine (R group, n =20); or 0.3% ropivacaine combined with 1 μg/ml sufentanil (RS group; n =20). We determined the concentrations of glucose, insulin, cortisol, epinephrine, norepinephrine, and prolactin before, during, and up to 48 h after surgery. Results: The concentrations of glucose and insulin increased in all the groups. The cortisol level increased in the C group while it decreased significantly in the RS group. Epinephrine and norepinephrine concentrations increased significantly after surgery in the C group, but not in the R and RS groups. The prolactin concentration increased in all the groups, and was higher in the RS group than in the other groups ( P =0.002). Post‐operative pain scores and analgesic requirement were lower in the R and RS groups. Conclusion: Epidural ropivacaine blunted the perioperative stress responses in elderly patients undergoing a RRP. The combination of epidural ropivacaine and sufentanil was associated with the most pronounced attenuation of the stress response.
ClinicalTrial.gov registration number: NCT01086956.