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  • Title: Epidural anesthesia can protect fibrinolytic function after surgery.
    Author: Wang TL, Qi YQ, Yang BX, Zhao L.
    Journal: Beijing Da Xue Xue Bao Yi Xue Ban; 2004 Aug 18; 36(4):383-9. PubMed ID: 15303131.
    Abstract:
    OBJECTIVE: To study the influences of different anesthesia techniques on stress response, coagulation and fibrinolytic function. METHODS: Thirty patients undergoing hysterectomy were randomized into three groups: Group E (continuous epidural anesthesia, n=10), Group G+E (epidural anesthesia combined general anesthesia, n=10) and Group G (general anesthesia, n=10). The blocking level with epidural anesthesia was maintained between T(6)-L(3) with 0.75% bupivacaine followed by Patient Controlled Epidural Analgesia (PCEA). General anesthesia was finished with convention followed by Patient-Controlled Analgesia (PCA). Blood samples were taken at pre-anesthesia (T(0)), the end of operation (T(1)) and postoperative 24 h (T(2)), 72 h (T(3)) to determine catecholamine concentration, coagulation and fibrinolysis variables. RESULTS: The nonepinephrine (NE) levels in Group E and Group G+E were not changed throughout the procedure, but obviously elevated in Group G (P<0.01) as compared with the baseline and those in the other Groups (P<0.05). The epinephrine (E) levels at T(1) in all groups were markedly increased as compared with those at T(0) and peaked (P<0.01), and then returned to the baseline at T(3). Fibrinogen (FIB) levels in all groups were obviously decreased at T(1), postoperatively elevated rapidly and peaked at T(3) (P<0.01). FIB levels at T(3) in groups G+E and G were much higher than that in Group E (P<0.05). The thrombin-anti-thrombin III complex (TAT) levels at T(1) in Group G+E and G were significantly increased as compared with those at Group E (P<0.01), and subsequently recovered to pre-anesthesia following surgery. TAT level in Group E was more decreased postoperatively than the baseline and those in the other groups (P<0.05). The D-dimer level in Group E over time was remarkably increased as compared with the baseline (P<0.05), and the D-dimer levels peaked at T(2) in all groups (P<0.01). The tissue-type plasminogen activator (t-PA) was more elevated than T(0) at T(1) (P<0.01) in all groups, and then returned to normal in Group E. But the marked decrease of t-PA in Groups G+E and G was revealed 72 h after surgery and became much lower than that in Group E (P<0.01). The plasminogen activating inhibitor-1(PAI-1) in Group G and Group G+E was more elevated perioperatively and became higher than that in Group E (P<0.01). CONCLUSION: Epidural anesthesia can preserve fibrinolytic function after lower-abdomen surgery by the inhibitory effects on surgical stress, PAI-1 and other mechanisms. The thromboprophylactic effects are revealed only following epidural anesthesia.
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