title: Randomized clinical trial of the anabolic effect of hypocaloric parenteral nutrition after abdominal surgery.
abstract: BACKGROUND
  The observed failure of hypocaloric nutrition to establish an anabolic state after surgery may reflect inadequate control for the type and quality of analgesia in the studies performed. This study was designed to test the hypothesis that hypocaloric nutrition induces anabolism in patients who receive effective segmental pain relief using perioperative epidural analgesia.
  
  
  METHODS
  Sixteen patients who underwent colorectal surgery and received epidural analgesia were randomly assigned to receive intravenous glucose either without (glucose only) or with amino acids (nutrition). Feeding was administered over 48 h from surgical skin incision until the second day after operation. Glucose provided 50 per cent of the patient's resting energy expenditure (REE). Amino acids were infused at rates that provided 20 per cent of REE. Leucine rate of appearance (Ra), leucine oxidation and non-oxidative leucine disposal (NOLD) were assessed by measuring L-[1-13C]leucine kinetics. A positive leucine balance, that is the difference between NOLD and leucine Ra, indicated anabolism.
  
  
  RESULTS
  After surgery, leucine Ra in the nutrition group was lower than that in the glucose only group (mean(s.d.) 88(25) versus 131(22) micromol per kg per h). The leucine balance remained negative in the glucose only group, whereas it became positive in the nutrition group (mean(s.d.) -24(3) versus 38(12) micromol per kg per h; P < 0.001).
  
  
  CONCLUSIONS
  Patients who receive hypocaloric parenteral nutrition can be rendered anabolic after colorectal surgery in the presence of epidural analgesia.
authors: Department of Anaesthesia, Montreal, Quebec, Canada. thomas.schricker@mcgill.ca
authors: T
authors: T
authors: Schricker
authors: L
authors: L
authors: Wykes
authors: L
authors: L
authors: Eberhart
authors: F
authors: F
authors: Carli
authors: S
authors: S
authors: Meterissian
mesh_terms: D000596:Amino Acids / Q000008:administration & dosage / Q000378:metabolism*; D015360:Analgesia, Epidural; D001786:Blood Glucose / Q000378:metabolism; D003110:Colonic Neoplasms / Q000378:metabolism / Q000601:surgery*; D004038:Diet, Reducing; D005260:Female; D005947:Glucose / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D007430:Intraoperative Care / Q000379:methods; D007930:Leucine / Q000008:administration & dosage / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000378:metabolism / Q000517:prevention & control; D010288:Parenteral Nutrition / Q000379:methods*; D011184:Postoperative Period
chemical_list: D000596:Amino Acids; D001786:Blood Glucose; D007930:Leucine; D005947:Glucose