Local metabolic changes in subcutaneous adipose tissue during intravenous and epidural analgesia

Abstract

Local metabolic changes in subcutaneous adipose tissue during intravenous and epidural analgesia.Ederoth, Per; Flisberg, Per; Ungerstedt, U; Nordström, C-H; Lundberg, Johan Published in: Acta Anaesthesiologica Scandinavica DOI: 10.1034/j.1399-6576.2002.460517.x Published: 2002 Link to publication Citation for published version (APA): Ederoth, P., Flisberg, P., Ungerstedt, U., Nordström, C-H., & Lundberg, J. (2002). Local metabolic changes in subcutaneous adipose tissue during intravenous and epidural analgesia. Acta Anaesthesiologica Scandinavica, 46(5), 585-591. DOI: 10.1034585-591. DOI: 10. /j.1399585-591. DOI: 10. -6576.2002 General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal Background: This clinical study aimed at investigating the impact of postoperative thoracic epidural analgesia on extracellular glycerol concentration and glucose metabolism in subcutaneous adipose tissue, using the microdialysis technique. The sympathetic nervous activity, which can be attenuated by epidural anesthesia, influences lipolysis and the release of glycerol. Methods: Fourteen patients who underwent major abdominal or thoraco-abdominal surgery were studied postoperatively over 3 days. For postoperative analgesia the patients were prospectively randomized to receive either thoracic epidural analgesia with a bupivacaine/morphine infusion (EPI-group, nΩ6) or a continuous i.v. infusion of morphine (MO-group, nΩ8). The concentration of glycerol, glucose and lactate in the abdominal and deltoid subcutaneous adipose tissue were measured using a microdialysis technique. Results:The abdominal glycerol levels were equal in both groups. In the deltoid region of the EPI-group, glycerol concentrations started to increase on Day 2, and reached significantly

The metabolism of the diabetic footIn vivo investigation with microdialysis

“…The interstitial concentrations of local metabolites can be affected by several factors-e.g., blood flow and hormones. As regards glycerol, an increase in local blood flow increases the transport of this compound away from the tissue, but it increases the transport of glucose to the tissue (Ederoth et al 2002). Our study showed higher concentrations of glycerol and similar levels of glucose and lactate in the ulcers.…”

“…The flow rate of the microdialysis system was 0.3 µL/min (Microdialysis A/B, Sweden, CMA 106). Under these conditions, the relative recovery of the metabolites measured is about 90-100% (Ederoth et al 2002). We analyzed the concentrations of glucose, lactate and glycerol, using a CMA 600 Drug Analyzer (Microdialysis A/B, Sweden).…”

Postoperative Lipolysis, Intraperitoneal and Subcutaneously during Epidural Analgesia

“…Glycerol release has been used in previous studies as a marker for detecting lipolysis in studies of the effects of epidural anesthesia on lipolysis in the postoperative course [9]. Subcutaneous and plasma analyzes of glycerol have shown higher levels in patients who do not have postoperative epidural catheters following gastrointestinal surgery [8]. Studies have also shown that local anesthetics as part of the epidural catheter have the ability to reduce lipolysis but pure morphine in the epidural catheter lacks this ability [8][9][10].…”

“…Subcutaneous and plasma analyzes of glycerol have shown higher levels in patients who do not have postoperative epidural catheters following gastrointestinal surgery [8]. Studies have also shown that local anesthetics as part of the epidural catheter have the ability to reduce lipolysis but pure morphine in the epidural catheter lacks this ability [8][9][10]. The results suggest that the autonomic nervous system mediates hormone release of lipolysis-initiating hormones [8].…”

“…Epidural anesthesia studies have been conducted to demonstrate lower levels of glycerol subcutaneously and in plasma in patients who had postoperative epidural anesthesia with local anesthesia as a constituent of the epidural catheter. It has been interpreted as reduced postoperative lipolysis in epidural anesthesia [8][9][10][11]. This study was improved of *Corresponding author: Kjell Jansson, Department of Surgery, University hospital of Örebro, Örebro University, Sweden.…”