Paravertebral Blockade

Paravertebral local anesthetic administration may provide postoperative pain relief by simultaneous somatic and visceral neural blockade and may provide a small reduction in the catecholamine, glucose, and cortisol response to cholecystectomy.!2

Epidural Local Anesthetics

The majority of data that demonstrate that regional anesthesia with local anesthetics may modify the surgical stress response come from studies in which epidural local anesthetics were used.12 12 These studies also document that most of the classic endocrine metabolic response is mediated by neural stimuli, whereas other responses (i.e., inflammatory responses) are generally mediated by humoral factors.12 12

The effect of epidural local anesthetics on endocrine function without surgery is slight.12

The effect of intra- and postoperative neural blockade with epidural local anesthetic on the surgical stress response is summarized in Figures 23-3 and 23-4 . It should be emphasized that the results shown in Figures 23-3 and 23-4 predominantly come from surgical procedures such as hysterectomy, vaginal surgery, inguinal herniotomy, minor orthopedic procedures, prostatectomy, and hip replacement. In contrast to these studies involving surgery of the lower half of the body, more than 25 studies on epidural local anesthetics and the stress response during procedures in the upper abdomen and thorax have failed to show a similarly pronounced inhibitory effect.12 2

Most of the studies contributing to Figures 23-3 and 23-4 have used bupivacaine, and, therefore, the question as to the differential modulatory effect of various local anesthetic agents cannot be answered.

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