POSTOPERATIVE GLUCOSE-TOLERANCE DURING EXTRADURAL ANALGESIA

Patients [13] undergoing lower abdominal gynecological surgery were allocated to general anesthesia (halothane and N2O) or general anesthesia plus extradural analgesia (T8-S5). I.v. glucose tolerance tests were performed on the day before surgery and 8 h after skin incision. All patients having extradural analgesia (T8) were pain-free following surgery. Extradural analgesia blocked the hyperglycemia response to surgery, but not the late postoperative cortisol response, although values were significantly less than in the group receiving general anesthesia alone. Impairment of glucose tolerance and of the insulin response to the glucose load in the period after operation were not influenced by extradural analgesia and this may have resulted from insufficient inhibition of the stress-induced release of catecholamines or cortisol, or both, or from blockade of stimulatory efferent sympathetic pathways to pancreatic islets.