title: Effects of thoracic epidural analgesia on glucose homeostasis after cardiac surgery in patients with and without diabetes mellitus.
abstract: OBJECTIVE
  Even moderate hyperglycaemia increases mortality/morbidity after coronary artery bypass grafting, stroke and myocardial infarction. The goal of this prospective study was to determine if using thoracic epidural analgesia from start of surgery until the end of the third postoperative day would blunt postoperative hyperglycaemia.
  
  
  METHODS
  Forty-four patients had diabetes mellitus, 60 did not; half of each group had an epidural with continuous local anaesthetics. All patients received continuous insulin infusions during the initial 24 h period beginning with surgery. Blood glucose was measured four times daily (fasting or 2-3 h post-prandial) until end of the third postoperative day.
  
  
  RESULTS
  For patients without diabetes, the epidural group had lower mean blood glucose and insulin requirements (P < 0.02) than controls during the initial 24 h period beginning with surgery. For patients with diabetes mellitus, thoracic epidural analgesia reduced mean blood glucose (P = 0.017) with unchanged insulin requirements. Epidural did not diminish the increase (vs. preoperative) in fasting blood glucose on the third postoperative day (32% vs. 22%, P < 0.001) for non-diabetics. Epidural analgesia was not able to attenuate hyperglycaemia during the first 3 postoperative days.
  
  
  CONCLUSIONS
  Epidural analgesia improved glucose homeostasis minimally during the initial 24 postoperative hours but did not attenuate hyperglycaemia during the subsequent 3 postoperative days.
authors.affiliation: Karolinska Hospital, Department of Thoracic Surgery and Anaesthesiology Stockholm, Sweden. russell.anderson@kirurgi.ki.se
authors.forename: R E
authors.initials: RE
authors.lastname: Anderson
authors.forename: J
authors.initials: J
authors.lastname: Ehrenberg
authors.forename: G
authors.initials: G
authors.lastname: Barr
authors.forename: K
authors.initials: K
authors.lastname: Brismar
authors.forename: A
authors.initials: A
authors.lastname: Owall
authors.forename: T
authors.initials: T
authors.lastname: Alserius
authors.forename: T
authors.initials: T
authors.lastname: Ivert
mesh_terms: D000368:Aged; D015360:Analgesia, Epidural; D001786:Blood Glucose / Q000378:metabolism*; D006348:Cardiac Surgical Procedures; D001026:Coronary Artery Bypass; D003924:Diabetes Mellitus, Type 2 / Q000097:blood*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011446:Prospective Studies
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin