Radical cystectomy as a cause of an increased neuroendocrine response

The present study compared the neuroendocrine response in patients un- dergoing conventional cystectomy with two postoperative pain management techniques: epidural analgesia (EA) and intermittent opioid analgesia (IOA) on adrenocorticotropic hormone (ACTH), cortisol, glucose levels for 48 hours. We hypothesize that appropriate analgesic regime can attenuate stress response re- action. Forty-four patients scheduled for radical conventional cystectomy were assigned to one of the two study groups: group A (n=22) with EA, group B (n=22) with IOA. The surgical stress factor induced significant hypothalamic - pituitary-adrenal (HPA) axis responses in both groups. The ACTH and cortisol levels were higher than baseline for both groups, but more significantly in group B. Blood glucose level was elevated few hours after the surgical intervention and was back to baseline level by the following morning. The results suggest that EA might have more advantages associated with reduced postoperative pain and attenuated neuroendocrine response when open access is the preferred op- erative technique. There is a need of randomized multicentre trials to evaluate the quality of life, the survival and the role of pain management at least 12 months after radical cystectomy.