Nitrogen-Sparing Effect of Epidural Administration of Local Anesthetics in Colon Surgery

Influence of patient-controlled epidural analgesia versus patient-controlled intravenous analgesia on postoperative pain control and recovery after gastrectomy for gastric cancer: a prospective randomized trial

“…In recent years, some perioperative protocols, including preoperative oral carbohydrate [24], epidural analgesia, early nasogastric tube removal, and early feeding with a low-fat liquid diet, have all aimed at suppressing perioperative stress to achieve a faster recovery from surgery and a quicker hospital discharge of patients [19]. Epidural blockade with local anesthetics can facilitate glucose utilization [25] and lessen the loss of body proteins [26]. Yardeni et al [27], in their randomized controlled trial comparing postoperative pain management techniques, reported an attenuated postoperative increase in serum cortisol and prolactin levels in their PCEA group, which meant that there was diminished activation of the hypothalamic-pituitary-adrenal axis response and a smaller surgery-associated neuroendocrine stress response in the PCEA group.…”

Postoperative Protein Sparing With Epidural Analgesia and Hypocaloric Dextrose

“…20 That epidural analgesia has protein sparing effects in the presence of isocaloric or hypercaloric intravenous nutrition has been shown before in patients undergoing colorectal surgery. 16,21 Epidural administration of bupivacaine preserved 76 g of protein after 5 days of intravenous nutrition consisting of 30 kcal/kg (50% carbohydrates and 50% fat) and 0.18 g N/kg per day. 21 In patients receiving nutrition with 0.1 g/kg N and 20 kcal/kg per day (60% fat, 35% carbohydrate, and 5% protein contribution) started 6 days before the operation epidural analgesia, restricted to the first 24 hours after surgery, reduced the oxidative protein loss by 20 g on the second postoperative day.…”

“…16,21 Epidural administration of bupivacaine preserved 76 g of protein after 5 days of intravenous nutrition consisting of 30 kcal/kg (50% carbohydrates and 50% fat) and 0.18 g N/kg per day. 21 In patients receiving nutrition with 0.1 g/kg N and 20 kcal/kg per day (60% fat, 35% carbohydrate, and 5% protein contribution) started 6 days before the operation epidural analgesia, restricted to the first 24 hours after surgery, reduced the oxidative protein loss by 20 g on the second postoperative day. 16 Hypercaloric intravenous nutrition providing approximately 2400 kcal per day, with 66% of nonprotein kcal as fat and 18 g N maintained total body protein after upper abdominal surgery only in patients receiving epidural analgesia.…”

A Randomized Controlled Trial of the Anticatabolic Effect of Epidural Analgesia and Hypocaloric Glucose

“…14 The majority of studies that dem-onstrate positive effects of neuraxial block on protein homeostasis were conducted in patients receiving alimentary support. [15][16][17] Hence, differentiation between the impact of the type of analgesia and changes resulting from nutritional factors was not possible. More recent studies controlled for the patients' feeding status indicate that, under fasting conditions, when energy intake is absent, epidural analgesia has no effect on protein catabolism.…”