INTRODUCTION: The evaluation of pain intensity is still a subject of research. Mostly psychological evaluations are used. We started to conduct biochemical evaluation in animal experiments. Now we present biochemical evaluation in postoperative pain in man. MATERIAL AND METHODS: In 67 patients herniotomy was done. For pre-emptive analgesia morphine and pethidine were used and the following indicators were measured: visual analogue scale (VAS), measurement of lipid spectra, saccharides and proteins, thioredoxin, super-oxide dismutase (SOD), glutathione peroxidase (GPx) and NAD(P)H-oxidase (NOX), and free radicals using electron paramagnetic resonance (EPR). Blood samples were taken and tested: before pre-medication and intervention, 4 h after and 24 h after intervention. RESULTS: Free radicals (FR) increased in individual samples during the postoperative course in pethidine and without pre-medication. After application of morphine the FR were insignificantly reduced. Statistically significant differences were found in albumin, prealbumin, apolipoprotein A, total cholesterol, atherosclerotic index, CRP, glucose, and thioredoxin (p ≤ 0.001). A greater difference was seen in VAS values between morphine and pethidine premedications (p ≤ 0.001). CONCLUSIONS: It was proved that the biochemical markers of lipid, protein and saccharide metabolisms and free radicals as well as singlet oxygen can serve as very good indicators of the intensity of pain and nociception. In patients it was proved that pre-emptive analgesia plays an important role in reducing the intensity of postoperative pain. From the three modalities of pre-emptive analgesia morphine represents the best solution.

Department of Anaesthesiology Resuscitation and Intensive Care 1 Faculty of Medicine Charles University Prague Centre of Pain Management Prague Czech Republic

Zobrazit více v PubMed

Křikava K, Kalla K, Yamamotová A, Rokyta R. Blood serum changes in patients with pain during bone fractures and acute pancreatitis. Neuro Endocrinol Lett. 2004;25:62–9. PubMed

Wall PD. The prevention of postoperative pain. Pain. 1988;33:289–90. PubMed

Wall PD, Melzack R, editors. 4th. Edinburgh: Churchill Livingston; 1999. Textbook of pain; pp. 165–81.

Rundshagen I, Kochs E, Schulte am Esch J. Surgical stimulation increases median nerve somatosensory evoked responses during isoflurane nitrous oxide anaesthesia. Br J Anaesth. 1995;75:598–602. PubMed

Abram SE, Yaksh TL. Morphine but not inhalation anesthesia, blocks post-injury facilitation. The role of pre-emptive suppression of afferent transmission. Anesthesiology. 1993;78:713–21. PubMed

Katz J, McCartney CJ. Current status of pre-emptive analgesia. Curr Opin Anaesthesiol. 2002;15:435–41. PubMed

Rokyta R, Stopka P, Kafunkova E, Krizova J, Fricova J, Holecek V. The evaluation of nociceptive intensity by using free radicals direct measurement by EPR method in the tail of anaesthetized rats. Neuro Endocrinol Lett. 2008;29:1007–14. PubMed

Gallez B, Schwartz HM. In vivo EPR: when how and why? NMR Biomed. 2004;17:223–5. PubMed

Štípek S, editor. Antioxidanty a volné radikály ve zdraví a v nemoci. 1st. Praha: Grada; 2000.

Mao Y, Zang L, Shi X. Singlet oxygen generation in the superoxide reaction. Biochem Mol Biol Int. 1995;36:227–32. PubMed

Rokyta R, Holeček V, Pekárková I, et al. Free radicals after painful stimulation are influenced by antioxidants and analgesics. Neuro Endocrinol Lett. 2003;24:304–9. PubMed

Rokyta R, Stopka P, Holeček Křikava K, Pekárková I. Direct measurement of free radicals in the brain cortex and the blood serum after nociceptive stimulation. Neuro Endocrinol Lett. 2004;25:252–6. PubMed

Fricova J, Stopka P, Krizova J, Yamamotova A, Rokyta R. The effect of laparotomy on hydroxyl radicals, singlet oxygen and antioxidants measured by EPR method in the tails of rats. Neuro Endocrinol Letters. 2009;30:373–6. PubMed

Holecek V, Liska J, Racek J, Rokyta R. The significance of free radicals and antioxidants due to the load induced by sport activity [Czech] Cesk Fysiol. 2004;53:76–9. PubMed

Davies MJ. The oxidative environment and protein damage. Biochim Biophys Acta. 2005;17:93–109. PubMed

Binda MM, Molinas CR, Koninckx PR. Reactive oxygen species and adhesion formation clinical implications in adhesion prevention. Hum Reprod. 2003;18:503–7. PubMed

Elkelani OA, Binda MM, Molinas CR, Koninckx PR. Effect of adding more than 3% oxygen to carbon dioxide pneumoperitoneum on adhesion formation in a lapa­roscopic mouse model. Fertil Steril. 2004;82:1616–22. PubMed

Persson M, van der Linden J. Intraoperative field flooding with warm humidified CO2 may help to prevent adhesion formation after open surger. Med Hypotheses. 2009;73:521–3. PubMed

Tsuchiya M, Sato EF, Inoue M, Asada A. Open abdominal surgery increases intraoperative oxidative stress: can it be prevented? Anesth Analg. 2008;107:1946–52. PubMed

Persson M, Svenarud P, van der Linden J. What is the optimal device for carbon dioxide deairing of the cardiothoracic wound and how should it be positioned? J Cardiothorac Vasc Anesth. 2004;18:180–4. PubMed

Anup R, Aparna V, Pulimood A, Balasubramanian KA. Surgical stress and the small intestine: role of oxygen free radicals. Surgery. 1999;125:560–9. PubMed

Souza AMB, Rogers MS, Wang CC, Yuen PM, Ng PS. Comparison of peritoneal oxidative stress during laparoscopy and laparotomy. J Am Assoc Gynecol Laparosc. 2003;10:65–74. PubMed

Eleftheriadis E, Kotzampassi K, Botsios D, Tzartinoglou E, Farmakis H, Dadoukis J. Splanchnic ischemia during laparoscopic cholecystectomy. Surg Endosc. 1996;10:324–6. PubMed

Taskin O, Sadik S, Onoglu A, et al. Adhesion formation after microlaparoscopic and laparoscopic ovarian coagulation for polycystic ovary disease. J Am Assoc Gynecol Laparosc. 1999;6:159–63. PubMed

Mantione KJ. Morphine signaling in Bos taurus and Equus caballus. Arch Med Sci. 2009;5:613–7.

Raddi P, Nagalingaswamy VP, Khatib F, Wang Y, Chandra SBC. A comparison of interpleural bupivacaine and intravenous pethidine for postoperative pain relief following open cholecystectomy. Arch Med Sci. 2009;5(1):57–62.

Hsiao PN, Chang MC, Cheng WF, et al. Morphine induces apoptosis of human endothelial cells through nitric oxide and reactive oxygen species pathways. Toxicology. 2009;4:83–91. PubMed