{
    "abstract": "It has been suggested that diabetes mellitus type 2 amplifies the endocrine-metabolic stress response to surgery, and patients become more catabolic during the postoperative period. The aim of this study, conducted in patients with diabetes mellitus type 2 scheduled to undergo elective colorectal surgery, was to determine whether the anabolic effects of intravenous amino acids are more pronounced when receiving perioperative epidural analgesia compared with patient-controlled analgesia with intravenous morphine.\nTwelve patients were randomly assigned to receive either epidural analgesia or patient-controlled analgesia with intravenous morphine for perioperative pain control. Protein and glucose kinetics were measured before surgery and on the second postoperative day using L-[1-C]leucine and [6,6H2]glucose infusion during a fasted and a fed (amino acid infusion) state.\nPreoperative parameters for glucose and protein kinetics were comparable in the fasted state for both groups. Postoperative amino acid infusion increased glucose concentration slightly (P = 0.124) and suppressed the endogenous rate of appearance of glucose (P < 0.0001) and glucose clearance (P < 0.0001) regardless of analgesia technique. The rate of appearance of leucine (P = 0.002), leucine oxidation (P < 0.0001), and protein synthesis (P = 0.026) increased, whereas net protein breakdown was decreased (P = 0.002), leading to a positive protein balance (P < 0.0001) in both groups. The increase in protein balance was greater in the epidural group compared with the patient-controlled analgesia group (P = 0.027).\nDiabetic patients receiving an amino acid infusion after surgery achieved a positive protein balance without hyperglycemia. This anabolic effect was greater in patients receiving epidural analgesia compared with patient-controlled analgesia with intravenous morphine.",
    "authors": [
        {
            "affiliation": "Department of Anesthesia and School of Dietetics and Human Nutrition, McGill University, Montreal, Canada.",
            "firstname": "Andrea Kopp",
            "initials": "AK",
            "lastname": "Lugli"
        },
        {
            "affiliation": null,
            "firstname": "Francesco",
            "initials": "F",
            "lastname": "Donatelli"
        },
        {
            "affiliation": null,
            "firstname": "Thomas",
            "initials": "T",
            "lastname": "Schricker"
        },
        {
            "affiliation": null,
            "firstname": "Linda",
            "initials": "L",
            "lastname": "Wykes"
        },
        {
            "affiliation": null,
            "firstname": "Franco",
            "initials": "F",
            "lastname": "Carli"
        }
    ],
    "conclusions": "Diabetic patients receiving an amino acid infusion after surgery achieved a positive protein balance without hyperglycemia. This anabolic effect was greater in patients receiving epidural analgesia compared with patient-controlled analgesia with intravenous morphine.",
    "copyrights": null,
    "doi": "10.1097/ALN.0b013e3181730239",
    "journal": "Anesthesiology",
    "keywords": [],
    "methods": null,
    "publication_date": "2008-05-24",
    "pubmed_id": "18497611",
    "results": "Preoperative parameters for glucose and protein kinetics were comparable in the fasted state for both groups. Postoperative amino acid infusion increased glucose concentration slightly (P = 0.124) and suppressed the endogenous rate of appearance of glucose (P < 0.0001) and glucose clearance (P < 0.0001) regardless of analgesia technique. The rate of appearance of leucine (P = 0.002), leucine oxidation (P < 0.0001), and protein synthesis (P = 0.026) increased, whereas net protein breakdown was decreased (P = 0.002), leading to a positive protein balance (P < 0.0001) in both groups. The increase in protein balance was greater in the epidural group compared with the patient-controlled analgesia group (P = 0.027).",
    "title": "Epidural analgesia enhances the postoperative anabolic effect of amino acids in diabetes mellitus type 2 patients undergoing colon surgery.",
    "xml": "<Element 'PubmedArticle' at 0x788503964a90>"
}