Objective:

Surgery and anesthesia cause otonomic, neuroendocrine and metabolic changes. The aim of this study is to compare the effects of epidural and intravenous analgesia on stress hormone responses during postoperative and perioperative periods of laparoscopic hiatal hernia operations.

Material and Methods:

32 patients (ASA I-II) with ages ranging from 20 to 60 years undergoing laparoscopic hiatal hernia surgery were included in the study and the patients were randomly divided into two groups as Group GA, general anesthesia combined with intravenous analgesia; Group EA; General anesthesia combined with epidural analgesia. Anesthesia was induced with1 μg kg-1 fentanyl, 2 mg kg-1 propofol and atracurium 0.5 mg kg-1, and general anesthesia was maintained with sevoflurane and air-oxygen mixture. In the Group GA, fentanyl was administered intermittently during intraoperative period. Postoperative analgesia was provided with tramadol in the recovery room, and with NSAI drugs and paracetamol in the surgical ward. In the Group EA, epidural catheterization was performed before induction of anesthesia through T8 -T10. As a bolus dosage, 0.5 % bupivacaine + 1 mg morphine in 10 mL normal saline was applied as administered to the patients. A 0.09 % NaCl, 80 mL and 0.5 % bupivacaine, 20 mL +10 mg morphine mixture was prepared for the postoperative period. Epidural infusion was started with the basal infusion of a bolus dosage of 2 mL delivered at a rate of 4 ml h-1 and 30 minute lock time for analgesia. Blood samples were collected before surgery, 30 min and 120 min after surgery and 24 h postoperatively for the determination of cortisol, ADH, insulin, glucose and IL-6 levels.

Results:

There were no significant intergroup differences in stress hormone levels before and after surgery except glucose levels at the 6th hour of postoperative period (p=0,021). In Groups GA and EA significant changes was determined throught the study related with surgical stress response.

Conclusion:

Thoracal epidural anesthesia and intravenous fentanyl supplemented group attenuate the surgical stress response in the same level. This result may be due to the inability of epidural analgesia to block noxious stimulation during laparoscopic surgery.

Keywords: Epidural analgesia, general anesthesia, stress response, laparoscopy