Epidural Analgesia Improves Postoperative Nitrogen Balance

Brandt, M. R.; Fernandes, A.; Mordhorst, R.; Kehlet, Henrik

doi:10.1097/00132586-197906000-00055

Cited by 29 publications

(37 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This degree of nitrogen wasting is in the same range as that seen clinically in the uncomplicated postoperative period (53)(54)(55). Previous studies have shown that postoperative nitrogen balance is improved when the neuroendocrine response to surgery is inhibited with epidural anesthesia (55). Our data further support the importance of hormonal factors in this setting of mild to moderate stress.…”

Section: Discussionsupporting

confidence: 84%

“…Nitrogen wasting of the magnitude observed in this study (-4 g/d), if sustained for 1 wk, would result in the loss of almost a full kilogram of lean body mass. This degree of nitrogen wasting is in the same range as that seen clinically in the uncomplicated postoperative period (53)(54)(55). Previous studies have shown that postoperative nitrogen balance is improved when the neuroendocrine response to surgery is inhibited with epidural anesthesia (55).…”

Section: Discussionsupporting

confidence: 54%

See 1 more Smart Citation

Role of counterregulatory hormones in the catabolic response to stress.

Gelfand¹,

Matthews²,

Bier³

et al. 1984

J. Clin. Invest.

222

View full text Add to dashboard Cite

Abstract. Patients with major injury or illness develop protein wasting, hypermetabolism, and hyperglycemia with increased glucose flux. To assess the role of elevated counterregulatory hormones in this response, we simultaneously infused cortisol (6 mg/M2 per h), glucagon (4 ng/kg per min), epinephrine (0.6 11g/m2 per min), and norepinephrine (0.8 group as was the elevation in plasma insulin. Most plasma amino acids rose rather than fell. In both infusion protocols nitrogen wasting was accompanied by only modest increments in 3-methylhistidine excretion (-20-30%) and no significant change in leucine flux.We conclude: (a) Prolonged elevations of multiple stress hormones cause persistent hyperglycemia, increased glucose turnover, and increased nitrogen loss; (b) The sustained nitrogen loss is no greater than that produced by cortisol alone; (c) Glucagon, epinephrine, and norepinephrine transiently augment cortisol-induced nitrogen loss and persistently accentuate hyperglycemia; (d) Counterregulatory hormones contribute to, but are probably not the sole mediators of the massive nitrogen loss, muscle proteolysis, and hypermetabolism seen in some clinical settings of severe stress.

show abstract

Section: Discussionsupporting

confidence: 84%

Section: Discussionsupporting

confidence: 54%

Role of counterregulatory hormones in the catabolic response to stress.

Gelfand¹,

Matthews²,

Bier³

et al. 1984

J. Clin. Invest.

222

View full text Add to dashboard Cite

show abstract

“…However, in general, epidural techniques have had only limited effects on the metabolic responses to abdominal procedures in a variety of studies; only the addition of more "distal" blockade of the neuroendocrine axis, using etomidate and somatostatin, to thoracic epidural anaesthesia has largely prevented postoperative alterations in protein metabolism. 13,16,30 The inhibition of the cortisol and other neuroendocrine responses to lower extremity and pelvic procedures by epidural techniques is much more complete than with more extensive abdominal procedures, s We conclude from the present study that postoperative oxygen consumption and metabolic rate following major abdominal surgery are not consistently diminished by epidural anaesthesia and analgesia despite substantial reduction in postoperative pain.…”

Section: Discussionmentioning

confidence: 53%

Epidural anaesthesia and analgesia do not affect energy expenditure after major abdominal surgery

et al. 1993

View full text Add to dashboard Cite

show abstract

“…A reduction in catecholamine excretion in surgical patients can be obtained by blocking neural pathways using spinal or epidural anaesthesia (Pflug & Halter, 1981). A highly significant improvement in N balance has been observed in patients undergoing pelvic surgery while receiving analgaesia by continuous infusion of the local anaesthetic bupivacaine into the epidural space (Brandt et al 1978) and an 11% reduction in protein turnover has been reported in patients anaesthetized in a similar fashion by Shaw et al (1987).…”

Section: G R O W T H P R O M O T I O N In Stressed Patientsmentioning

confidence: 89%

Growth promoters in humans

Burns

1990

Proc. Nutr. Soc.

View full text Add to dashboard Cite

The maintenance and enhancement of body composition is an energy-dependent process and is impossible without an adequate supply of energy and protein. In certain circumstances, alteration of the normal pattern of protein deposition and metabolism may be considered necessary. Drugs have been used with some success in attaining this end in three distinct clinical areas. First, they are proving effective in the treatment of short-statured children, second, a variety of strategies have been used in an attempt to prevent loss of lean body mass in traumatized and septic patients, and finally and most controversially, the anabolic influences of a number of hormones have been used by sportsmen and women in a bid to improve athletic performance.

show abstract

Epidural Analgesia Improves Postoperative Nitrogen Balance

Cited by 29 publications

References 0 publications

Role of counterregulatory hormones in the catabolic response to stress.

Role of counterregulatory hormones in the catabolic response to stress.

Epidural anaesthesia and analgesia do not affect energy expenditure after major abdominal surgery

Growth promoters in humans

Contact Info

Product

Resources

About