THE DYNAMICS OF SERUM CORTISOL AND INSULIN IN HIP JOIT ARTHROPLASTY

The hip joint arthroplasty has high risk of perioperative stress-response and insulin-resistance. The analgesia technics differ in terms of anti-nociceptive and anti-stress protec-tion. The aim of our study was to analyze the serum cortisol and insulin dynamics during perioperative period in patients undergone total hip arthroplasty according to the anaesthesia and analgesia techniques. Results and Discussion. The average serum cortisol level among all patients was at the reference values all stages of the study, but there was some increase after the onset of anesthesia followed by a decrease during the operation. In the morning of the first postoperative day the level of cortisol returned to baseline. When analyzing the level of cortisol depending on the methods of intraoperative anesthesia, its insignificant growth at the beginning of anesthesia prior to surgery in all groups was found to be within the range of 20-40 nmol/L from the baseline level. At the traumatic moment of surgery, in comparison with the previous stage, cortisol decreased in all groups of regional anesthesia: in the group of spinal anesthesia by 71 nmol/L, in the group of paravertebral+caudal anesthesia – by 53 nmol/L, in the group of nerve blocks – by 13 nmol/L, whereas in the group of general anesthesia cortisol increased by 47 nmol/L. This may indicate a more powerful antinociceptive protection from regional methods. In the morning of the first postoperative day, the level of cortisol recovered to baseline in the group of spinal anesthesia, in the group of nerve blocks and general anesthesia – was by 15 nmol/L higher than the baseline, and in the group of paravertebral+caudal anesthesia – by 38 nmol/L lower than the baseline level. Among the methods of postoperative analgesia, the following thing was observed: in the systemic opioid analgesia group, the level of cortisol in the morning of the first postoperative period was by 31 nmol/L higher than the baseline level before the operation, in the group of epidural analgesia – lower by 73 nmol/L, and in the group paravertebral analgesia – lower by 13 nmol/L. This may indicate a more adequate analgesia from prolonged epidural and paravertebral analgesia compared with systemic opioid analgesia. In analyzing the dynamics of cortisol in gender groups, there was a significant increase in its level at the beginning of anesthesia in men, by 61 nmol/L. Patients with coxarthrosis had higher levels of cortisol in the plasma than patients with fractures, although this difference was statistically significant only at the beginning of anesthesia before surgery (p = 0,02). Conclusions: Regional analgesia provides a positive effect on the serum cortisol and insulin level in patients undergone hip joint arthroplasty. The expression of compensatory responses by index of cortisol/insulin is more stable in patients having peripheral regional anesthesia, in comparison with neuraxial methods and general anesthesia.