Effect of Postoperative Pain on Surgical Stress Response

  • H. Kehlet
Part of the Developments in Critical Care Medicine and Anesthesiology book series (DCCA, volume 29)


Pain is one of the sequelae of acute injury and may participate in the release and maintenance of the surgical stress response. Furthermore, pain-induced reflex responses may adversely influence respiratory function, increase cardiac demands, decrease intestinal motility and initiate skeletal muscle spasm. Therefore, there is a common belief that alleviation of acute pain may also reduce the surgical stress response and improve outcome.


Epidural Analgesia Cortisol Response Major Abdominal Surgery Neural Blockade Epidural Opioid 
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  1. 1.
    Kehlet H: Modification of responses to surgery and anesthesia by neural blockade: Clinical implications, Neural Blockade in ClinicalAnesthesia and Management of Pain. Edited by Cousins MJ, Bridenbaugh PO, Philadelphia, J. B. Lippincott 1987, pp. 145–188Google Scholar
  2. 2.
    Kehlet H: Role of neural stimuli and pain, Mediators of Sepsis. Edited by Lamy M, Thijs LG. Berlin, Springer Verlag, 1992, pp. 196–205CrossRefGoogle Scholar
  3. 3.
    Kehlet H: General vs. regional anesthesia, Principles and Practice of Anesthesiology. Edited by Rogers MC, Tinker JH, Covino BG, Longnecker DE. St. Louis, C.V. Mosby, 1993, pp. 1218–1234Google Scholar
  4. 4.
    Carli F, Emery PW: Intra-operative exttrdural block with local anaesthetic. Acta Anaesthesiol Scand 34: 263–266, 1990PubMedCrossRefGoogle Scholar
  5. 5.
    Carli F, Webster J, Pearson M, et al: Protein metabolism afterabdominal surgery: Effect of 24-h extradural block with local anaesthetic. Br J Anaesth 67: 729–734, 1991PubMedCrossRefGoogle Scholar
  6. 6.
    Dahl JB, Rosenberg J, Kehlet H: Effect of thoracic epidural etidocaine 1.5% on somatosensory evoked potentials, Cortisol and glucoseduring cholecystectomy. Acta Anaesthesiol Scand 36: 378–382, 1992PubMedCrossRefGoogle Scholar
  7. 7.
    Naito Y, Tamai S, Shingu K, et al: Responses of plasma adrenocorticotropic hormone, Cortisol and cytokines during and after upper abdominal surgery. Anesthesiology 77: 426–431, 1992PubMedCrossRefGoogle Scholar
  8. 8.
    Watters JM, March RJ, Desai D, et al: Epidural anaesthesia and analgesia do not affect energy expenditure after major abdominal surgery. Can J Anaesth 40: 314–319, 1993PubMedCrossRefGoogle Scholar
  9. 9.
    Christensen T, Kehlet H: Postoperative fatigue. World J Surg 17: 220–225, 1993PubMedCrossRefGoogle Scholar
  10. 10.
    Heindorff H, Schulze S, Mogensen T, et al: Hormonal and neural blockade prevents the postoperative increase in amino acid clearance and urea synthesis. Surgery 111: 543–590, 1992PubMedGoogle Scholar
  11. 11.
    Kehlet H: Surgical stress—The role of pain and analgesia. Br J Anaesth 63: 189–195, 1989PubMedCrossRefGoogle Scholar
  12. 12.
    Møller IW, Dinesen K, Søndergård S, et al: Effect of patient-controlled analgesia on plasma catecholamine, Cortisol and glucoseconcentrations after cholecystectomy. Br J Anaesth 61: 160–164, 1988PubMedCrossRefGoogle Scholar
  13. 13.
    Zwarts SJ, Hasenbos MAMW, Gielen MJM, Kho H-G: The effect of continuous epidural analgesia with sufentanil and bupivacaine during and after thoracic surgery on the plasma Cortisol concentration and pain relief. Reg Anesth 14: 183–188, 1989PubMedGoogle Scholar
  14. 14.
    Liem TH, Booij LH, Gielen MJ, et al: Coronary artery bypass grafting using two different anesthetic techniques. Part III: Adrenergic responses. J Cardiothorac Vasc Anesth 6: 162–167, 1992PubMedCrossRefGoogle Scholar
  15. 15.
    Sheinin B. Sheinin M, Asantila R, et al: Sympatho-adrenal and pituitary hormone responses during and immediately after thoracic surgery—Modulation by four different pain treatments. Acta Anaesthesiol Scand 31: 762–767, 1987CrossRefGoogle Scholar
  16. 16.
    Dahl JB, Kehlet H: Non-steroidal anti-inflammatory drugs—Rationale for use in severe postoperative pain. Br J Anaesth 66: 703–712, 1991PubMedCrossRefGoogle Scholar
  17. 17.
    Rademaker BMP, Sih IL, Kalkman CJ, et al: Effects of intrapleurally administered bupivacaine 0.5% on opioid analgesic requirements and endocrine response during and after cholecystectomy: A randomized double-blind controlled study. Acta Anaesthesiol Scand 35: 108–112, 1991PubMedCrossRefGoogle Scholar
  18. 18.
    Kho HG, van Egmond JV, Eijk RJR, Kapteyns WM: Lack of influence of acupuncture and transcutaneous stimulation on the immunoglobulin levels and leucocyte counts following upper abdominal surgery. Eur J Anaesthesiol 8: 39–45, 1991PubMedGoogle Scholar
  19. 19.
    Kho HG, Kloppenborg PWC, van Egmond J: Effects of acupuncture and transcutaneous stimulation analgesia on plasma hormone levels during and after major abdominal surgery. Eur J Anaesthesiol 10: 197–208, 1993PubMedGoogle Scholar
  20. 20.
    Hamid SK, Scott NB, Sutcliffe NP, et al: Continuous coeliac plexus blockade plus intermittent wound infiltration by bupivacaine following upper abdominal surgery: A double-blind randomised study. Acta Anaesthesiol Scand 36: 534–539, 1992PubMedCrossRefGoogle Scholar
  21. 21.
    Schulze S, Roikjær O, Hasselstrøm L, et al: Epidural bupivacaine and morphine plus systemic indomethacin eliminates pain but not systemic response and convalescence after cholecystectomy. Surgery 103: 321–327, 1988PubMedGoogle Scholar
  22. 22.
    Schulze S, Møller IW, Bang U, et al: Effect of combined prednisolone, epidural analgesia and indomethacin on pain, systemic response and convalescence after cholecystectomy. Acta Chir Scand 156: 203–209, 1990PubMedGoogle Scholar
  23. 23.
    Schulze S, Sommer P, Bigler D, et al: Effect of combined prednisolone, epidural analgesia and indomethacin on the systemic response after colonic surgery. Arch Surg 127: 325–331, 1992PubMedCrossRefGoogle Scholar
  24. 24.
    Dahl JB, Rosenberg J, Dirkes WE, et al: Prevention of postoperative pain by balanced analgesia. Br J Anaesth 64: 518–520, 1990PubMedCrossRefGoogle Scholar
  25. 25.
    Webster J, Barnard M, Carli F: Metabolic response to colonic surgery: Extradural vs. continuous spinal. Br J Anaesth 67: 467–469, 1991PubMedCrossRefGoogle Scholar
  26. 26.
    Dirkes WE, Rosenberg J, Lund C, Kehlet H: The effect of intrathecal lidocaine and combined intrathecal lidocaine and epidural bupivacaine on electrical sensory thresholds. Reg Anesth 16: 262–264, 1991PubMedGoogle Scholar

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© Springer Science+Business Media Dordrecht 1994

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  • H. Kehlet

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