Facebook
Twitter
LinkedIn
Email
 |
Checking for direct PDF access through Ovid | |
Excerpt
Background and goal of study: Transurethral prostatectomy TURP includes no external tissue damage and comparison with suprapubic postatectomy SP will define the contribution of somatic and splanchnic trauma in surgical stress responses. We measured IL-6, the best index of the severity of surgery [1], C-reactive protein CRP, which is the main component of acute phase response and cortisol representing the endocrine response.
Materials and methods: We studied two groups of 15 patients each, who underwent TURP and SP under spinal anaesthesia (lidocaine 5% 2 ml in L4-5 space, T8-T10 block). Age and duration were comparable (TURP: 71 ± 6, 7 years, 57 ± 19 min, SP:70 ± 6, 6 years, 67 ± 14 min). We measured IL-6, CRP and cortisol blood levels before surgery (BL), IL-6 and cortisol 7 h later and CRP at 24 h (POST). We used Mann-Witney U and paired Student's t-test for statistical analysis.
Results: All three parameters increased as postoperatively in TURP: IL-6 P < 0.005, 95% confidence interval (CI): 23-87 pg mL−1), CRP P < 0.000 (95% CI 22-36 mg L−1) and cortisol P < 0.000 (CI 94-284 pg mL−1) and in SP:IL-6 P < 0.005 (CI 47-191), CRP P < 0.000 (CI 42-74) and cortisol P < 0.000 (CI 131-259). However IL-6 and CRP values were higher in SP compared to TURP:IL-6 P < 0.05 (CI 31-144), CRP: P < 0.005 (CI 11-53) while cortisol increased similarly in both techniques. FIGURE
Conclusion: Splanchnic and surface surgical trauma additively contribute to the acute phase response while same cortisol increases in TURP and SP confirm that visceral neuronal afferents are responsible for the adrenocortical response. Attenuated surgical stress response in TURP allows earlier convalescence and hospital discharge in comparison to SP.
