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Sökning: id:"swepub:oai:DiVA.org:oru-22804" > Optimization of the...

Optimization of the perioperative anaesthetic care for prostate cancer surgery : clinical studies on pain, stress response and immunomodulation

Fant, Federica, 1972- (författare)
Örebro universitet,Institutionen för hälsovetenskap och medicin
Gupta, Anil, Docent (preses)
Örebro universitet,Institutionen för hälsovetenskap och medicin
Axelsson, Kjell, Professor (preses)
Örebro universitet,Institutionen för hälsovetenskap och medicin
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Andersson, Swen-Olof, Docent (preses)
Örebro universitet,Institutionen för hälsovetenskap och medicin
Kalman, Sigridur, Professor (opponent)
Anestesikliniken, Karolinska universitetssjukhuset, Huddinge
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 (creator_code:org_t)
ISBN 9789176688731
Örebro : Örebro universitet, 2012
Engelska 97 s.
Serie: Örebro Studies in Medicine, 1652-4063 ; 69
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)
Abstract Ämnesord
Stäng  
  • Prostate cancer (PC) is the most common cancer form in men. Surgery is the treatment of choice for localized form of PC and half of all surgical procedures are radical retropubic prostatectomies (RRP). In the first two studies, we compared the efficacy of thoracic epidural analgesia to patientcontrolled analgesia (PCA) with intravenous morphine (I) and to patientcontrolled local analgesia by intra-abdominal injection of local anaesthetic(LA) (II) in treating postoperative pain after RRP. In studies III and IV we evaluated the effects of thoracic epidural analgesia compared to PCA with morphine in reducing the surgical stress reaction, inflammatory response (III) as well as the immune suppression (IV) following RRP. In studies I and II, we found better pain relief both at rest and on coughing, lower morphine consumption and better respiratory function postoperatively in patients having epidural analgesia. However, we did not register differences in time to home readiness or length of hospital stay. Painmanagement did not significantly affect health-related quality of life. In study III, early surgical stress response (plasma glucose and cortisol) was reduced two hours after the skin incision in patients having epidural analgesia compared with those having intravenous morphine analgesia but no differences in inflammatory mediators were seen except IL-17 which was lower in the epidural group. In study IV, no differences were found between epidural and PCA groups in leucocyte subpopulations, immunecell activation after mitogen stimulation or in natural killer cell cytotoxicityas a measure of innate immunity. We observed a low incidence of side effects and postoperative complications in all studies with no differences between the groups. In summary, thoracic epidural analgesia provided better postoperative pain relief, improved respiratory function and reduction in early stress response to radical retropubic prostatectomy, without any significant effects on inflammation or immune suppression.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Anestesi och intensivvård (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Anesthesiology and Intensive Care (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kirurgi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Surgery (hsv//eng)

Nyckelord

Radical retropubic prostatectomy
epidural analgesia
patientcontrolled local anaesthesia
patient-controlled analgesia
surgical stress response
local and general inflammatory reaction
immune response
Anaesthesiology
Anestesiologi
Surgery
Kirurgi

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