Abstract

Trauma results in an increased resting energy expenditure, a negative nitrogen balance, and an altered glucose turnover. These metabolic reactions are most likely initiated by catabolic hormones. Total parenteral nutrition cannot inhibit the catabolic response to trauma, but it can improve protein synthesis in various organs and, thereby, decrease tissue loss, particularly in skeletal muscle. The traumatic response to surgery was studied in patients under general anesthesia or regional blockade. Epidural anesthesia caused a relative suppression of several catabolic hormones and showed a positive effect on nitrogen balance. Of particular interest was the observation that levels of somatomedin-A were reduced in those patients receiving epidural blocks.