Effect of epidural blockade on protein, glucose, and lipid metabolism in the fasted state and during dextrose infusion in volunteers

Background: To interpret correctly the results from studies performed durin g surgery and anesthesia it is necessary to dissect the separate effect of the anesthetic technique itself. The purpose of this study was to investiga te the metabolic effects of epidural blockade (T7-S1) with bupivacaine 0.25 % after 12 h fasting and during administration of 4 mg . kg(-1) . min(-1) d extrose in six healthy volunteers. Methods: Each volunteer was assigned to randomly undergo a 6-h multiple sta ble isotope infusion study (3 h fasted, 3 h dextrose infusion) with or with out epidural blockade. L-[1-C-13]leucine, [6,6-H-2(2)]glucose, and [1,1,2,3 ,3-H-2(5)]glycerol were infused to measure protein synthesis, breakdown, an d amino acid oxidation; glucose production and clearance; and lipolysis. Pl asma concentrations of glucose, lactate, glycerol, free fatty acids, insuli n, and glucagon were determined. Results: Epidural blockade with bupivacaine had no influence on protein oxi dation, breakdown and synthesis, glucose production, glucose clearance and lipolysis in the fasted state. Plasma concentrations of metabolic substrate s and hormones also were not affected. Dextrose infusion significantly incr eased glucose clearance and plasma concentrations of glucose and insulin, w hile endogenous glucose production and Lipolysis decreased to a similar deg ree in both groups. Protein synthesis, breakdown, and oxidation did not cha nge during dextrose infusion, Conclusions: Epidural blockade with bupivacalne in the absence of surgery h as no effect on fasting protein, glucose, and Lipid metabolism. Epidural bl ockade does not modify the inhibitory influence of dextrose administration on endogenous glucose production and lipolysis.