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1 Department of Anesthesia, 2 School of Dietetics and Human Nutrition, McGill University, Montreal, Quebec, Canada H3A 1A1
The purpose of this study was to test the hypothesis that epidural
blockade with local anesthetic improves the anticatabolic effects of
glucose after colorectal surgery. Sixteen patients were randomly
assigned to undergo a 6-h stable isotope infusion study (3 h fasted,
3 h glucose infusion at 4 mg · kg
1 · min1) on the second postoperative day with or without
perioperative epidural blockade. Protein synthesis, breakdown and
oxidation, and glucose production and clearance were assessed by
L-[1-13C]leucine and
[6,6-2H2]glucose. Epidural blockade did not
affect protein and glucose metabolism in the fasted state. Glucose
infusion increased glucose clearance (P < 0.05),
accompanied by an increase in the respiratory quotient
(P < 0.05) and a decrease in leucine oxidation
(P < 0.05) only in the presence of epidural blockade.
An inverse correlation (r = 
0.74, P < 0.05) between changes in glucose clearance and leucine oxidation was
observed. In conclusion, epidural blockade facilitates whole body
glucose uptake and inhibits endogenous protein oxidation after
abdominal surgery, indicating a shift from a protein to a more
glucose-dominated substrate utilization.
surgery; bupivacaine; insulin; glucagon; cortisol; isotopes; glucose; leucine
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