The effects of preemptive epidural analgesia on postoperative pain and stress response to percutaneous nephrolithotomy

It is aimed to investigate the effect of preemptive epidural analgesia on patients underwent percutaneous nephrolithotomy (PNL) with general anesthesia.Fifty patients undergo elective PNL surgery, ASA I-II, in the 18-70 age, were divided randomly into two groups. In patients Group E 13 mL 0.25% levobupivacain + 2 mL 100 µ fentanyl were given to L1-2 epidural space at 20 min before induction of general anesthesia. Patients lied in the bottom position during the 15 minute. All patients was intubated using appropriate spiral endotracheal tube. Stress hormones (glucose, cortisol, insulin) levels and the inflammatory response (CRP) were measured in different measurement times including preoparative period, 30 min after the surgical incision, postoperative 1. hours, 24 hours. In the both groups, the concentration of sevofluran adjusted to hemodinamic parameters and to enough anesthetic depth. In addition, doses of fentanil were given when necessary. Hemodynamic parameters, fentanyl and sevofluran requirement were recorded in the intraoperative and postoperative period. Hemodynamic parameters, analgesic requirement, postoperative pain scores and side effects were recorded.Systolic Blood Pressure (SBP) was measured in Group E lower than Group A 2. min after intubation and after the extubation (p<0.05). Diastolic Blood Pressure (DBP) was measured in Group E lower than Group A at the 5. min and 120. min after the intubation (p<0.05). Heart rate (HR) values in Group E lower than in Group A at the 5. min after the induction and intubation (p<0.05). Glucose and insulin levels of the patients in group E was significantly lower than those group A at postoperatively 1. hours (p<0.05). CRP and cortisol values were similar between the groups. Sevouran and fentanyl using more reduced in the patients of group E than those group A.In our study, it is concluded that preemptive lumbar epidural analgesia had produced the condition of minimaly depressive hemodynamia, reduced anesthetic and analgesic requirements, faster emergence, and depressive changes in stress and inflammatory response during the effect of single-dose epidural analgesia.