POSTOPERATIVE GLUCOSE TOLERANCE DURING EXTRADURAL ANALGESIA

Thirteen patients undergoing lower abdominal gynaecologicalsurgery were allocated to general anaesthesia (halothane andnitrous oxide) or general anaesthesia plus extradural analgesia(T8-S5) I v. glucose tolerance tests were performed on the daybefore surgery and 8 h after skin incision. All patients havingextradural analgesia (T8) were pain-free following surgery.Extradural analgesia blocked the hyperglycaemic response tosurgery but not the late postoperative cortisol response, althoughvalues were significantly less than in the group receiving generalanaesthesia alone. Impairment of glucose tolerance and of theinsulin response to the glucose load in the period after operationwere not influenced by extradural analgesia and this may haveresulted from insufficient inhibition of the stress-inducedrelease of catecholamines or cortisol, or both, or from blockadeof stimulatory efferent sympathetic pathways to pancreatic islets. ^*Present address. Department of Anesthcsiology, University ofWashington, School of Medicine, ZA-14, Seattle, Washington 98195,U.S A.