Epidural blockade suppresses lipolysis during major abdominal surgery☆

Abstract

Epidural block suppresses lipolysis during and 2 hours after major abdominal surgery without affecting plasma glycerol or FFA concentrations.

Effect of postoperative epidural analgesia on morbidity and mortality following surgery in medicare patients

“…20 Our previous analysis of Medicare patients undergoing total-hip replacement also did not demonstrate any benefit of postoperative epidural analgesia in decreasing 7-day or 30-day mortality. 10 Whether the many physiologic benefits of epidural analgesia 8,9,[21][22][23][24][25][26] contributed to a decrease in postoperative mortality is unclear, as we did not find a decrease in the perioperative morbidities that we examined. Subgroup analysis in the Cooperative Overview of Randomized Trials of Regional Anesthesia metaanalysis showed that neuraxial block decreased the odds of deep-vein thrombosis by 44%, pulmonary embolism by 55%, transfusion requirements by 50%, pneumonia by 39%, and respiratory depression by 59%.…”

Thoracic Epidural Anesthesia Improves Early Outcomes in Patients Undergoing Off-pump Coronary Artery Bypass Surgery

“…In this context, the addition of regional to general anesthesia, with its demonstrated benefits in adult and pediatric patients undergoing major surgery, is receiving increasing attention from anesthetists and cardiac surgeons. [2][3][4][5][6][7] Regional anesthesia may attenuate adverse physiologic stress responses associated with cardiothoracic surgery, including alterations in circulatory (tachycardia, hypertension, vasoconstriction), metabolic (increased catabolism and cortisol release), immunologic (impaired immune response), and hemostatic (platelet activation) systems. 8 -12 Two recent randomized, controlled trials 3,4 have investigated the potential benefits of thoracic epidural anesthesia in patients undergoing conventional CABG with cardiopulmonary bypass (CPB) and cardioplegic arrest.…”

“…There was no evidence of statistically significant differences in the incidence of vasodilator support (either intra-or (7, 21) 7.5 (7,10) Missing data are minimal (Ͻ 10%). CCS ϭ Canadian Cardiovascular Society; CVA ϭ cerebral vascular accident; GA ϭ general anesthesia only; GAE ϭ general anesthesia plus epidural; IQR ϭ interquartile range; NYHA ϭ New York Heart Association; TIA ϭ transient ischemic attack.…”

“…The median time from surgery to discharge was 1 day shorter for patients in the GAE group compared with those in the GA group (5 days, IQR [5][6] vs. 6 days, IQR [5][6][7]; see table 2). The estimated HR (GAE/GA) of 1.39 (95% CI [1.06, 1.82]; P ϭ 0.017), indicates that, at any given time, the "hazard" of discharge from hospital for a patient in the GAE group was approximately 40% higher than that of a patient in the GA group (i.e., GAE patients were significantly more likely to be discharged earlier than those in the GA group).…”

Anesthesia and analgesia for colon surgery

“…An elegant series of investigations in patients undergoing open colon surgery indicates that a combination of epidural anesthesia and analgesia in conjunction with nutrition maximizes the perioperative preservation of normal protein catabolism, muscle mass, lipolysis, and glucose metabolism compared with systemic opioids. [36][37][38] All of these factors (better perioperative analgesia, reduction in fatigue, attenuated postoperative catabolism and muscle loss, reduced deconditioning) probably explain the improved postoperative quality of life observed in the epidural analgesia group.…”