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Effect of Combined Prednisolone, Epidural Analgesia, and Indomethacin on the Systemic Response After Colonic Surgery
Svend Schulze, MD;
Peter Sommer, MD;
Dennis Bigler, MD;
Mette Honnens, MD;
Allan Shenkin, PhD;
Anne M. Cruickshank, MB;
Klaus Bukhave, CandScient;
Henrik Kehlet, MD
Arch Surg. 1992;127(3):325-331.
Abstract
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• 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.
(Arch Surg. 1992;127:325-331)
Author Affiliations
From the Departments of Surgical Gastroenterology F (Drs Schulze, Sommer, and Honnens) and Anesthesiology (Dr Bigler), Bispebjerg University Hospital, Department of Biochemistry and Nutrition, The Technical University of Denmark (Mr Bukhave), and Department of Surgical Gastroenterology, Hvidovre University Hospital (Dr Kehlet), Copenhagen; and the Institute of Biochemistry, Royal Infirmary, Glasgow, Scotland (Dr Shenkin and Ms Cruickshank).
Footnotes
Accepted for publication October 5, 1991.
Presented in part at the Second International Congress on the Immune Consequences of Trauma, Shock and Sepsis, Munich, Federal Republic of Germany, March 8, 1991.
Reprint requests to Department of Surgical Gastroenterology, Bispebjerg Hospital, Bispebjerg Bakke, DK-2400 Copenhagen NV, Denmark (Dr Schulze).
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