Epidural blockade suppresses lipolysis during major abdominal surgery.
OBJECTIVE
The purpose of the study was to investigate the effect of thoracic epidural administration of local anesthetic, i.e., epidural block on perioperative lipolysis.


METHODS
Fourteen patients undergoing elective colorectal surgery were randomly assigned to receive either general anesthesia combined with epidural block (EDA, n = 7) or general anesthesia alone (control, n = 7). The rates of glycerol appearance (R(a) glycerol), i.e., lipolysis, were assessed by the stable isotope tracer [1,1,2,3,3-(2)H(5)]glycerol before, during, and 2 hours after the operation. Plasma concentrations of metabolic substrates (glycerol, free fatty acids [FFA], lactate) and hormones (insulin, glucagon, cortisol) were also determined.


RESULTS
In the EDA group, R(a) glycerol decreased to lower intra- and postoperative values than in the control group (P <.05). Perioperative plasma concentrations of glycerol, FFA, lactate, and insulin remained unaltered with both anesthetic techniques. Intraoperative plasma glucagon and cortisol concentrations were lower in the EDA group than in the control group (P <.05).


CONCLUSIONS
Epidural block suppresses lipolysis during and 2 hours after major abdominal surgery without affecting plasma glycerol or FFA concentrations.
Lattermann
Ralph
R
Department of Anesthesia, McGill University, Montreal, Quebec, Canada.
Carli
Franco
F
Schricker
Thomas
T
D000368:Aged; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D003106:Colon / Q000601:surgery; D003903:Deuterium; D013505:Digestive System Surgical Procedures; D005230:Fatty Acids, Nonesterified / Q000097:blood; D005260:Female; D005934:Glucagon / Q000097:blood; D005990:Glycerol / Q000493:pharmacokinetics; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007328:Insulin / Q000097:blood; D019344:Lactic Acid / Q000097:blood; D008066:Lipolysis / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010100:Oxygen / Q000097:blood; D012007:Rectum / Q000601:surgery
D005230:Fatty Acids, Nonesterified; D007328:Insulin; D019344:Lactic Acid; D005934:Glucagon; D003903:Deuterium; D005990:Glycerol; D010100:Oxygen; D006854:Hydrocortisone