ABSTRACT
Increased whole body protein breakdown and amino acid oxidation resulting in nitrogen loss, are typical features of altered protein homeostasis after surgery. Because protein represents both structural and functional components extensive loss of lean and tissue mass may cause delayed wound healing, compromised immune function and muscle weakness leading to prolonged convalescence and morbidity, neuro-axial blockade with epidural local anesthetics has been demonstrated to attenuate catabolic response to major abdominal surgery. The aim of this study is to compare the ant catabolic affect of levobupivacaine, ropivacaine and general anesthesia by the perioperative kinetics of blood ureaglucose, and hormones as glucagons, insulin, cortisol, and metabolites as lactate. Thirty patients with bladder cancer, scheduled for elective cyst prostatectomy followed by elective reconstruction of the bladder with small bowel after informed consent, patients were divided into 3 groups, each 10 patients, the first group was received general anesthesia, group II epidurally levobupivacaine was used, group III ropivacaine was used epidurals. Levobopivacaine was 0-5%, while ropivacaine was used, postoperative infusion epidurally was prepared as 5ml/hour and with 2ml increment a lockout time of 20 minutes, and levobupivacaine group was received 0.125% solution concentration, while ropivacaine was received at a higher concentration 0.2%. Blood samples were taken one before induction of general anesthesia or injection of local anesthetic, the second intraoperatively and 3 blood samples at the 3days postoperatively. All sample [5ml each were immediately centrifuged at 4 C and the plasma stored at -70Co until analysis. Ureaglucose, lactate, hormones [insulin, glucagons, cortisol] were determined, plasma concentrations of glucose, lactate were determined enzymatically. Insulin, glucagons and cortisol were quantified with radioimmunoassay. There was significant increase in blood sugar in group I in the first and second day postoperatively it was 150 +/- 20, 150 +/- 30respectively, there was significant in crease in insulin concentration in group II, III in the second day postoperatively it was 57 +/- 20, 80 +/- 15 respectively, and in the third day postoperatively, it was 90 +/- 25, 95 +/- 20respectively. There was significant decrease in insulin level in group I during surgery and in the first, second day postoperatively. It was 29 +/- 18, 30 +/- 30, 30 +/- 20 respectively. There was significant increase in glucagons level in group I in the third day postoperatively; it was 10 +/- 3. Blood urea level was significantly lower in group II and III in third day postoperatively. Blood cortisol was significantly increased in the 1st and second day postoperatively in group I. The study concluded that postoperative epidural levobupivacaine or ropivacaine have nearly equally attenuate the catabolic response after major abdominal surgery, by preventing postoperative protein breakdown with out affecting glucose metabolism