Postoperative Protein Sparing With Epidural Analgesia and Hypocaloric Dextrose

Abstract

Perioperative epidural analgesia and hypocaloric dextrose infusion suppress the postoperative increase in amino acid oxidation, thereby saving more than 100 g of lean body mass per day.

Strategies to attenuate the catabolic response to surgery and improve perioperative outcomes

“…13 The extent of protein sparing was greater than that previously achieved with other pharmacological and nutritional interventions including growth hormone, glutamine, and total parenteral nutrition. In addition, patients receiving epidural analgesia could be rendered anabolic by supplementing hypocaloric glucose with amino acids.…”

Perioperative catabolism

“…Epidural analgesia together with the perioperative infusion of hypocaloric glucose (200 gÁday -1 ) has been shown to minimize the oxidative loss of protein after colorectal surgery, thereby saving muscle mass at a rate of 100 gÁday -1 . 119 The extent of protein sparing was greater than that previously achieved with other pharmacological and nutritional interventions, including growth hormone, glutamine, and total parenteral nutrition. 56,66,120 In addition, patients receiving epidural analgesia could be rendered anabolic by supplementing hypocaloric glucose with amino acids.…”

Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations

“…Ample evidence has accumulated in open surgery to identify the peripheral and central nervous system as a common pathway triggering the catabolic responses to tissue trauma. Blockade of these pathways by epidural anaesthesia and local anaesthetic blocks prevents the increase in circulating counter‐regulatory hormones, thereby minimising insulin resistance and limiting protein catabolism48 and hyperglycaemia 49. The physiological effects of epidural anaesthesia may serve as a rationale for improved respiratory and cardiovascular outcomes after general, urological and vascular procedures as reported by meta‐analyses and randomised controlled trials 50, 51…”