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REGIONAL ANESTHESIA

Perioperative Glucose Infusion and the Catabolic Response to Surgery: The Effect of Epidural Block

Ralph Lattermann, MD^*, Franco Carli, MD, MPhil^*, Linda Wykes, PhD, and Thomas Schricker, MD, PhD^*

*Department of Anesthesia and School of Dietetics and Human Nutrition, McGill University, Montreal, Quebec, Canada

Address correspondence and reprint requests to Franco Carli, MD, Department of Anesthesia, McGill University, Royal Victoria Hospital, Room S9.16, 687 Pine Ave. West, Montreal, Quebec, Canada H3A 1A1. Address e-mail to franco.carli{at}mcgill.ca

Although the nitrogen-sparing properties of epidural block and IV glucose on the days after surgical trauma have been well established, their metabolic effects during the acute phase of the stress response remain unclear. Therefore, in this study we investigated the effect of epidural block on glucose and protein kinetics during and immediately after surgery in patients receiving IV glucose at 2 mg · kg^-1 · min^-1. Sixteen patients undergoing colorectal surgery received either general anesthesia with epidural block with bupivacaine (EDA; n = 8) or general anesthesia alone (control; n = 8). Glucose and protein kinetics were determined during and 2 h after the operation by stable isotope tracers [6,6-²H₂]glucose and L-[1-¹³C]leucine. Plasma concentrations of glucose, insulin, cortisol, and glucagon were also determined. Epidural block attenuated the perioperative increase in plasma glucose concentration (P < 0.05). The rate of appearance of glucose (R_a glucose) and endogenous glucose production (EGP) were slower in the EDA group than in control subjects during (R_a glucose, EDA 13.2 ± 1.0 versus control 15.3 ± 1.8 µmol · kg^-1 · min^-1; P < 0.05; EGP, EDA 1.2 ± 1.2 versus control 3.8 ± 1.7 µmol · kg^-1 · min^-1; P < 0.05) and after the operation (P > 0.05). Whereas protein breakdown and amino acid oxidation decreased in both groups (P < 0.05), whole-body protein synthesis remained unchanged. Insulin levels increased with both anesthetic techniques (P < 0.05). Intraoperative plasma concentrations of cortisol and glucagon were smaller in the EDA group (P < 0.05). The intraoperative suppression of EGP by exogenous glucose was more pronounced in the presence of epidural block. However, epidural block failed to exert a protein-sparing effect during the acute phase of the stress response in patients receiving IV glucose.

IMPLICATIONS:We investigated the effect of epidural block on perioperative glucose and protein kinetics in patients receiving IV glucose infusion. Endogenous glucose production and plasma glucose concentration were smaller in the presence of epidural block. However, epidural block did not modify perioperative protein metabolism during the administration of IV glucose.

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