Effects of epidural preemptive analgesia on stress reaction in retroperitoneal laparoscopic adrenalectomy surgery: a randomized controlled study.

OBJECTIVE To compare the effects of general anesthesia combined with epidural preemptive analgesia with general anesthesia on stress reaction in the retroperitoneal laparoscopic surgery. METHODS Forty patients with adrenal tumors undergoing retroperitoneal laparoscopic surgeries were randomly assigned into general anesthesia combined with epidural preemptive analgesia group (GE) and general anesthesia group (G). Each group had 20 cases. In the GE group, before the induction of general anesthesia, T10-T11 epidural puncture was performed and 0.2% bupivacaine 5-10 ml was injected to maintain the anesthesia level at T4. In the G group, normal saline was injected as control. After entry into the operation room (X0), before surgery (X1), 30 min after pneumoperitoneum (X2), 60 min after pneumoperitoneum (X3), 10 min after extubation (X4), the mean arterial pressure (MAP) and heart rate (HR) were recorded. The concentration of plasma endothelin (ET) and calcitonin gene-related peptide (CGRP) were detected. Meanwhile, isoflurane inhalation MAC and intervention situations were recorded. RESULTS At X1-X3, MAP in the GE group was significantly lower than that in the G group (P < 0.05). At X2-X4 HR in two groups was significantly faster than at X1 (P < 0.05). At X4 HR in the GE group was significantly lower than that in the G group (P < 0.05). At X3 and X4, ET and CGRP were significantly lower than those in the G group (P < 0.05). At X2 and X3, ET in the GE group was significantly higher than that at X1 (P < 0.05). At X3, CGRP in the GE group was significantly higher than that at X1 (P < 0.05). At X2, X3 and before pneumoperitoneum, isoflurane MAC in the GE group was significantly lower than that in the G group (P < 0.05). At X2 and X3, isoflurane MAC in two groups was significantly higher than that during pneumoperitoneum (P < 0.05). CONCLUSION Compared with general anesthesia, general anesthesia combined with epidural preemptive analgesia can effectively alleviate patients' stress reaction under retroperitoneal laparoscopic surgery.