The Effect of Epidural Levobupivacaine and Fentanyl on Stress Response and Pain Management in Patients Undergoing Percutaneous Nephrolithotomy.

Objective The perioperative stress response of patients who were scheduled to have percutaneous nephrolithotomy under epidural anaesthesia with opioids and local anaesthetics has not been investigated in detail yet. Our hypothesis is that the stress response following percutaneous nephrolithotomy can be lessened by epidural analgesia. Methods A total of 48 patients, between 18-65 years of age and ASA I-II, for whom elective percutaneous nephrolithotomy was planned, were randomly divided into two groups namely: Group GA (n = 24): general anaesthesia by sevoflurane and fentanyl and postoperative intravenous PCA; Group GE (n = 24): epidural anaesthesia and general anaesthesia together with postoperative epidural analgesia (0.125% levobupivacaine + fentanyl). Blood levels for glucose, insulin, prolactin and cortisol were evaluated prior to anaesthesia, after surgical incision, immediately following percutaneous dilatation and postoperative 24th hour. Intraoperative hemodynamic parameters and postoperative pain scores together with preoperative and postoperative hematocrit values were recorded. Results Postoperative pain scores were found to be statistically significantly lower (p < 0.05) in Group GE at all measurement times. Intraoperative blood loss was statistically significantly lower in Group GE (p = 0.011). When hemodynamic parameters were compared, at all time intervals except baseline measurement, blood pressure and heart rate were significantly lower in Group GE (p < 0.05). Levels of stress hormones, glucose, cortisol, insulin and prolactin remained significantly lower in Group GE. Conclusion We think that epidural anaesthesia, performed in addition to general anaesthesia, may be a comfortable anaesthesia method with its suppressive effects on intraoperative and postoperative stress response together with reduced pain scores in the postoperative period.