Investigation of Effects of Epidural Anaesthesia Combined with General Anaesthesia on the Stress Response in Patients Undergoing Hip and Knee Arthroplasty

Abstract

Objective: To investigate the effects of general anaesthesia and general+epidural anaesthesia on the stress response which was evaluated with the adrenocorticotrophic hormone (ACTH), cortisol, insulin, and glucose levels and the haemodynamic parameters.Methods: Forty two, American Society of Anesthesiologists physiologic status I-II, patients undergoing hip and knee arthroplasty were randomized into two groups; general anaesthesia (Group G) and general anaesthesia+epidural anaesthesia (Group E). Epidural anaesthesia: patients in Group E received epidural anaesthesia with 0.5% bupivacaine, a lumbar epidural catheter was placed and after achieving sensorial block at T10 dermatome, general anaesthesia was commenced. General anaesthesia was standardized in both groups. Further, plasma ACTH, cortisol, insulin and glucose levels were determined at preoperative=t1, after the surgical incision=t2, postoperative 2 nd hour=t3 and postoperative 24 th hour=t4. Perioperative heart rate, blood pressures, pain scores and morphine consumption were also determined. . The insulin levels were higher compared with the baseline values at t3, and glucose was higher at t3 and t4 in both groups. Haemodynamic parameters were stable in Group E, and pain scores and morphine consumption were higher in Group G than in Group E. Results Conclusion:Our results suggest that general anaesthesia combined with epidural anaesthesia suppressed the stress response, which was evaluated with ACTH, cortisol levels and haemodynamic parameters; however, this method was ineffective to attenuate the increase in glucose and insulin levels.Keywords: ACTH, arthroplasty, epidural anaesthesia, cortisol, insulin, stress response Amaç: Genel anestezi ve genel anestezi ile birlikte uygulanan epidural anestezinin, adrenokortikotropik hormon (ACTH), kortizol, glukoz ve insülin düzeylerinin yanı sıra hemodinamik değişiklikler ile değerlendirilen stres yanıt üzerindeki etkilerinin araştırılmasıdır.Yöntemler: Kalça ve diz artroplastisi yapılan, Amerikan Anestezistler Derneği fizyolojik durumu I-II olan, 42 hasta rastgele genel anestezi (Grup G) ve genel anestezi+epidural anestezi (Grup E) gruplarına ayrıldı. Epidural anestezi; Grup E'deki hastalara %0,5 bupivakain ile uygulandı, lomber epidural kateter yerleştirildi. Duyu bloğunun T10 seviyesine ulaştığı tespit edildikten sonra hastalara genel anestezi uygulandı. Genel anestezi; her iki grupta da standardize edildi. Plazma ACTH, kortizol insülin ve glukoz düzeyleri, preoperatif=t1, cerrahi insizyondan sonra=t2, postoperatif 2. saat=t3 ve 24. saat=t4'te ölçüldü. Hastaların perioperatif kalp hızı, kan basınçları ve postoperatif ağrı skorları ve morfin tü-ketimleri tespit edildi. Bulgular: ACTH, Grup G'de, Grup E'den yüksekti [Grup G, t2: 71,4±39,9 pg mL -1 ve t3: 578,6±566,1 pg mL -1, Grup E'de t2: 20,2±16,2 pg mL -1 , t3: 56,3±73,6 pg mL -1 (p<0,001)]. Kortizol, Grup G'de, Grup E'den yüksekti [Grup G, t3: 33 Her iki grupta da insülin postoperatif 24. saatte ve glukoz postoperatif 2 ve 24. saatlerde preoperatif düzeylere ...

Intrathecal morphine administration reduces postoperative pain and peripheral endocannabinoid levels in total knee arthroplasty patients: a randomized clinical trial

“…Surgical procedures induce a rapid increase in circulating cortisol levels and more effective analgesia blunts this postoperative cortisol response [43, 52, 59]. Interactions between stress and the endocannabinoid system are well established in rodents [60, 61].…”

Femoral nerve block versus fascia iliaca block for pain control in knee and hip arthroplasties

“…[ 1 ] Despite the obvious benefits of TKA and THA, there are still many intractable problems such as pain and vomiting after operation. [ 2 ] Usually, several pain management protocols are used to relieve postoperative pain, such as local infiltration anesthesia, [ 3 ] peripheral nerve blocks, [ 4 ] epidural anesthesia, [ 5 ] and multimodal analgesia. [ 6 , 7 ] However, there is still no uniform gold standard for effective pain management after total knee and hip arthroplasty.…”

Dynamics of Biochemical Markers of Operational Stress in the Blood of Patients with Surgical Interventions on the Lumbar Spine Depending on the Type of Anesthesia

“…В результаті автори прийшли до висновку, що нейро-аксіальна анестезія зменшує стрес-реакцію, проте призначення пероральних розчинів вуглеводів не виявило значного впливу на післяопераційний стрес [5]. Під час артропластики кульшового і ко-лінного суглобів було проведено оцінку впливу за-гальної анестезії у поєднанні з епідуральною анес-тезією, за рівнем адренокортикотропного гормону (АКТГ), кортизолу, інсуліну та глюкози В результаті було встановлено, що цей метод зменшував стрес-реакцію, яка оцінювалася за рівнем АКТГ, проте рівень глюкози та інсуліну після операції не знижу-валися [6]. Існують також дані, що при хірургічній корекції сколіотичної деформації хребта продовже-на епідуральна аналгезія вірогідно знижує рівень ендокринно-метаболічної відповіді в післяоперацій-ному періоді в порівнянні з використанням опіоїдів, забезпечує високий ступінь захисту після прове-дення хірургічних втручань.…”