Effect of combined prednisolone, epidural analgesia, and indomethacin on the systemic response after colonic surgery
S. Schulze, P. Sommer, D. Bigler, M. Honnens, A. Shenkin, A. M. Cruickshank, K. Bukhave and H. Kehlet
Department of Surgical Gastroenterology F, Bispebjerg University Hospital, Copenhagen, Denmark.
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.
