%0 Journal Article
%T A randomized controlled trial of the anticatabolic effect of epidural analgesia and hypocaloric glucose.
%A Lattermann R
%A Wykes L
%A Eberhart L
%A Carli F
%A Meterissian S
%A Schricker T
%J Reg Anesth Pain Med
%V 32
%N 3
%D May-Jun 2007
%M 17543818
%F 5.564
%R 10.1016/j.rapm.2007.02.009
%X <B>OBJECTIVE: </B>The goal of the present study was to investigate whether epidural analgesia exerts a protein-sparing effect after colorectal surgery in the presence of hypocaloric glucose supply initiated with surgical skin incision.<BR><B>METHODS: </B>We randomly allocated 10 patients to receive general anesthesia combined with epidural anesthesia with bupivacaine, followed by epidural analgesia using bupivacaine/fentanyl, and 10 patients to receive general anesthesia, followed by patient-controlled analgesia with intravenous morphine. All patients received a 48-hour infusion of glucose 10% from surgical skin incision until the second day after surgery. The glucose infusion rate provided 50% of the patient's resting energy expenditure. Kinetics of protein and glucose metabolism were assessed by a stable-isotope tracer technique (L-[1-(13)C]leucine and [6,6-(2)H(2)]glucose).<BR><B>RESULTS: </B>The rate of appearance of leucine increased in the intravenous-analgesia group (112 +/- 29 to 130 +/- 25 micromol/kg/h) 2 days after surgery, and this increase was more pronounced than in the epidural analgesia group (preoperative 120 +/- 24, postoperative 123 +/- 22 micromol/kg/h, P < .05). Leucine oxidation rate increased in the intravenous analgesia group from 17 +/- 8 to 23 +/- 8 micromol/kg/h and in the epidural group from 17 +/- 6 to 19 +/- 7 micromol/kg/h without the difference between the groups reaching statistical significance (P = .067). Nonoxidative leucine disposal remained unaltered in both groups. No differences in glucose metabolism were seen between the groups.<BR><B>CONCLUSIONS: </B>Epidural analgesia inhibits the increase in whole-body protein breakdown in patients receiving perioperative hypocaloric glucose infusion initiated with surgical skin incision. However, oxidative protein loss, protein synthesis, and glucose metabolism are not affected by epidural analgesia.