The present project investigated the effect of epidural blockade with local anesthetic on the catabolic stress response during and immediately after abdominal surgery in fasting patients and during infusion of glucose at 2 mg·kg-1·min-1. The kinetics of glucose and protein metabolism were assessed by the stable isotope tracers [6,6-2H2]glucose and L-[1-13C]-leucine. / Epidural blockade was associated with a lower plasma glucose concentration and glucose production when compared to control subjects in the fasted state. Whole body protein breakdown, amino acid oxidation and protein synthesis were suppressed during surgery, and epidural blockade had no modifying effect on perioperative protein metabolism. The suppression of endogenous glucose production by exogenous glucose was more pronounced in the presence of epidural blockade. Perioperative protein metabolism, however, was not influenced by epidural blockade during glucose infusion. / Although epidural blockade suppressed glucose metabolism both in the fasted state and during glucose administration, it failed to exert a modifying effect on perioperative protein metabolism.

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The potential effects of nutritional support with amino acids or dextrose and epidural blockade on the catabolic response to surgery were investigated in diabetic patients undergoing colorectal surgery. Protein and glucose metabolism were assessed with a stable isotope infusion technique using the two stable isotopes L-[1-13C]leucine and [6,6-2H2 ]glucose. / 1. The first intervention of a postoperative infusion of amino acids avoided pronounced hyperglycaemia in diabetic patients after colorectal surgery and achieved a positive protein balance compared to dextrose. / 2. The second intervention of a short term infusion of amino acids postoperatively blunted protein breakdown and stimulated protein synthesis. This resulted in a positive protein balance in patients with epidural blockade compared to patient controlled analgesia with intravenous morphine. With regard to glucose metabolism, amino acid supply after surgery decreased glucose clearance and endogenous glucose production independent from type of analgesia.

No description available.