Protein balance in nondiabetic versus diabetic patients undergoing colon surgery: effect of epidural analgesia and amino acids.
BACKGROUND
Surgical injury provokes a stress response that is thought to be pronounced in patients with diabetes mellitus type 2 (DM2) leading to intensified catabolism. The aim of this study was to compare the effects of perioperative epidural analgesia (EDA) versus patient controlled analgesia (PCA) and amino acid infusion on postoperative metabolism in patients with and without DM2.


METHODS
For this study, 12 nondiabetic patients and 12 diabetic patients undergoing colorectal surgery were randomly assigned to 4 groups (n = 6 per group) receiving either EDA (nondiabetic EDA and diabetic EDA [DEDA group]) or PCA with morphine (nondiabetic PCA and diabetic PCA) for perioperative pain control. Protein and glucose kinetics were measured on the second postoperative day using L-[1-13C]leucine and [6,6-2H2]glucose infusion during a fasted state and a 3-hr fed state with amino acid infusion.


RESULTS
The transition from the fasted to fed state suppressed endogenous rate of appearance (Ra) of glucose (P G 0.001) with a distinct effect for the DEDA group (P G 0.001). The Ra of leucine and the endogenous rate of appearance of leucine tended to be lower in the DEDA group(P = 0.056 and P = 0.07). Leucine oxidation was more suppressed in the DEDA group (P = 0.02) and when receiving amino acids(P = 0.001). Diabetic patients achieved a higher protein balance than nondiabetic patients (P = 0.032) and when receiving EDA instead of PCA (P = 0.012) or infusion of amino acids (P = 0.014).


CONCLUSIONS
A short-term infusion of amino acids reduced protein breakdown, increased protein synthesis, and rendered protein balance positive. This anabolic effect was pronounced in diabetic patients with EDA compared with nondiabetic patients or PCA, respectively, and prevented an undesirable hyperglycemia.
Lugli
Andrea Kopp
AK
Department of Anesthesia, University Hospital, 4031 Basel, Switzerland. akopp@uhbs.ch
Donatelli
Francesco
F
Schricker
Thomas
T
Kindler
Christoph
C
Wykes
Linda
L
Carli
Franco
F
D000368:Aged; D000596:Amino Acids / Q000008:administration & dosage* / Q000493:pharmacokinetics; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D001786:Blood Glucose / Q000378:metabolism; D002045:Bupivacaine / Q000008:administration & dosage; D003082:Colectomy; D003108:Colonic Diseases / Q000150:complications / Q000601:surgery*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000378:metabolism*; D004044:Dietary Proteins / Q000008:administration & dosage* / Q000493:pharmacokinetics; D005215:Fasting / Q000097:blood; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D005934:Glucagon / Q000097:blood; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D007263:Infusions, Parenteral; D007328:Insulin / Q000097:blood; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D010149:Postoperative Pain / Q000517:prevention & control*; D011659:Pulmonary Gas Exchange; D011792:Quebec; D016896:Treatment Outcome
D000596:Amino Acids; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D001786:Blood Glucose; D004044:Dietary Proteins; D007328:Insulin; D009020:Morphine; D005934:Glucagon; D005283:Fentanyl; D002045:Bupivacaine