Effects of Abdominal Surgery Under General Anaesthesia and of Postoperative Analgesic Therapy on Splanchnic Exchange of Some Blood Borne Energy Metabolites

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Abstract
Sixteen patients with gallbladder disease, but otherwise healthy, were studied in connection with cholecystectomy. For postoperative analgesia, seven patients were given a posterior splanchnic blockade, 30 ml of 0.5 % plain lidocaine, and nine patients were given fentanyl intramuscularly in a dose of 3.5 μg/kg b.w. Immediately after the operation and before analgesia, the arterial blood concentrations of glucose, lactate, glycerol, 3‐hydroxybutyrate, and free fatty acids increased significantly. The splanchnic exchange of these metabolites was also significantly increased, except for glucose, the splanchnic release of which was significantly reduced. Induction of analgesia, by both methods, was followed by a rapid significant decrease of the arterial blood concentration of glycerol, which tended to rise later when the analgesia disappeared. The arterial blood concentration of glucose and lactate showed a tendency to decrease slowly following both kinds of analgesia, while the arterial blood concentration of 3‐hydroxybutyrate remained stable. The splanchnic release of glucose was significantly reduced after administration of fentanyl, while it increased significantly following splanchnic blockade, the splanchnic glucose release being correlated to arterial blood pH. The splanchnic release of 3‐hydroxybutyrate was significantly reduced during maximal analgesia in both groups. The splanchnic uptakes of glycerol and free fatty acids were correlated to their splanchnic inflows.