Pither C E, Bridenbaugh L D, Reynolds F
Anaesthetic Unit, St Thomas's Hospital Medical School, London.
Br J Anaesth. 1988 May;60(6):730-2. doi: 10.1093/bja/60.6.730.
The plasma cortisol and glucose responses to cholecystectomy were studied in 20 healthy patients. Ten patients received preoperative intercostal nerve blocks of the 6th to 12th nerves bilaterally using 0.5% bupivacaine with adrenaline 250 micrograms. The control group had the same quantity of adrenaline infiltrated into the intercostal space. Both groups had general anaesthesia with endotracheal intubation and controlled ventilation. In the non-blocked group, the mean cortisol concentration increased from a control value of 182.5 nmol litre-1 to a peak of 686.2 nmol litre-1 at 5.5 h after incision. In the blocked group the baseline serum cortisol concentration was 283.8 nmol litre-1 and it increased to a similar peak at 5.5 h. There were no significant differences between groups. The baseline plasma glucose concentration was also higher in the blocked group (4.45 mmol litre-1 compared with 3.94 mmol litre-1), but after a brief increase following the performance of the block decreased to only 14% above control values. The unblocked group exhibited substantial increase following the start of the surgery which continued for the duration of the study period to end at a mean of 6.48 mmol litre-1. These differences were significant (P less than 0.001). It is concluded that bilateral intercostal blocks may inhibit the glucose response to surgery, but have no effect on the cortisol response.
对20名健康患者进行了胆囊切除术时血浆皮质醇和葡萄糖反应的研究。10名患者双侧接受了第6至12肋间神经的术前阻滞，使用0.5%布比卡因加250微克肾上腺素。对照组在肋间间隙注入等量肾上腺素。两组均采用气管插管全身麻醉和控制通气。在未阻滞组，皮质醇平均浓度从对照值182.5纳摩尔/升在切口后5.5小时升至峰值686.2纳摩尔/升。在阻滞组，基线血清皮质醇浓度为283.8纳摩尔/升，在5.5小时时升至相似峰值。两组间无显著差异。阻滞组的基线血浆葡萄糖浓度也较高（4.45毫摩尔/升，而对照组为3.94毫摩尔/升），但在阻滞操作后短暂升高后仅降至比对照值高14%。未阻滞组在手术开始后出现大幅升高，并在研究期持续，最终平均达到6.48毫摩尔/升。这些差异具有显著性（P小于0.001）。结论是双侧肋间阻滞可能抑制手术时的葡萄糖反应，但对皮质醇反应无影响。
