Hemodynamic and Neuroendocrinal Stress Response in Relation to Intrathecal Opioids and Isobaric Bupivacaine as Pre-Emptive Analgesics in Laparoscopic-Assisted Vaginal Hysterectomy

Certain complications of major surgery (e.g. myocardial infarction, pulmonary and thromboembolic complications, stress ulcers and post operative fatigue) can be attributed to the general metabolic response to surgery. Perioperative and postoperative regional anesthesia have been associated with decreased postoperative morbidity by lowering the incidence of such complications. As compared with local anesthetics, spinal opioids have selective segmental analgesia without sensory, motor blockade or autonomic block. Also, spinal opioids analgesia is not associated with central nervous system or cardiac excitability, toxicity or tachyphylaxis. The aim of the current study is to compare the hemodynamic and neuroendocrinal stress response of low dose intrathecal sufentanil in combination with low dose isobaric bupivacaine in patients undergoing laparoscopic-assisted vaginal hysterectomy under general anaesthesia with that of intrathecal morphine and bupivacaine injection. Patients were randomly allocated into one of two equal groups (each 10 patients). Group (A): Patients of this group received 10µ gm intrathecal sufentanil in 1ml saline and 1ml isobaric bupivacaine 0.5%. Group (B): Patients of this group received 100µ gm intrathecal morphine in 1ml saline and 1ml isobaric bupivacaine 0.5%. Sufentanil group (A) tend to have overall low mean arterial blood pressure and heart rate than the morphine (B) group. There was no statistical difference between respiratory criteria (arterial oxygen saturation and breathing rate) between the two groups. Neuroendocrinal patterns (Cortisol and glucose levels) were generally higher in the sufentanil group (A) than in the morphine group (B). Conclusion: Both morphine in a dose of 100µ gm and sufentanil in a dose of 10µ gm are safe adjuncts to isobaric bupivacaine as intrathecal analgesia. They are both safe and are not associated with major hemodynamic or neuroendocrinal side-effects within the limits of such doses. Morphine in such dose has a slightly better hemodynamic and neuroendocrinal profile than sufentanil.