Dependence of perioperative glycemia on analgesia technique for hip joint arthroplasty
Aim. The hip joint arthroplasty has high risk of perioperative hyperglycemia due to stress response and insulin resistance. The analgesia technics differ in terms of provided analgesia and anti-stress protection. The aim of our study was analyzing of blood glucose, insulin and HOMA-index dynamics during perioperative period in patients who underwent total hip arthroplasty according to the anaesthesia and analgesia techniques.
Material and Methods. The study included 150 patients undergoing primary total hip joint replacement. We analyzed the dynamics of blood glucose, insulin and HOMA-index in relation to four variants of intraoperative anaesthesia and three variants of postoperative analgesia techniques, pathology type and patients' gender. Tests were taken before and during surgery, as well as at the 1st postoperative day.
Results and Discussion. The preoperative glycemia level before surgery among all groups did not differ significantly (р>0,1). In the operating room, after the general anaesthesia administration but before the start of the surgery, the patients demonstrated significant increase in glycemia up to 6,3 mmol/L, and it was significantly higher compared to groups of patients with nerve blocks, paravertebral+caudal anaesthesia and spinal anaesthesia (р<0,01). At the traumatic stage of surgery, glycemia was significantly higher in groups of general anaesthesia and nerve blocks, 6,98 аnd 6,43 mmol/L, respectively. At the 1st postoperative day, the highest level of glycemia was detected in patients receiving systemic opioid analgesia, whose level of glycemia was 0,87 mmol/L higher than the initial value before surgery; in the group of epidural analgesia, this difference was 0,1 mmol/L, and in the group of paravertebral analgesia - 0,42 mmol/L. The analysis of the insulin level , depending on the methods of intraoperative analgesia, revealed the following: the lowest level of insulin at the traumatic stage of the operation in the group of spinal anaesthesia was found to be 2,61 mIU/L higher compared to the level prior to the operation, and the values of this group significantly differed from other groups at this stage of the study (p<0,05). At all other stages of the study, the level of insulin among intraoperative anesthesia groups did not differ significantly (p>0,05). The difference in insulin levels between postoperative analgesia groups at any stage of the study was not statistically significant (p>0,1). In the intraoperative period, there was a decrease in the HOMA index in the group of spinal anesthesia, while in all other groups this rate was gradually increasing. The higher HOMA index was found in patients operated on under general anesthesia, who received systemic opioid anesthesia after surgery. The level of glycemia, insulin and HOMA did not significantly differ in any stage of the study between gender groups and groups by type of pathology: coxarthrosis or fractures (p>0,1).
Conclusion. Regional analgesia provides a positive effect on the level of glycemia, insulin secretion and insulin resistance development in patients undergoing hip joint arthroplasty.
Сeliksular MC, Saraсoglu A, Yentur E. The Influence of Oral Carbohydrate Solution Intake on Stress Response before Total Hip Replacement Surgery during Epidural and General Anaesthesia. Turk J Anaesthesiol Reanim 2016; 44: 117-23. https://doi.org/10.5152/TJAR.2016.65265
Gottschalk A, Rink B, Smektala R, Piontek A, Ellger B, Gottschalk A. Spinal anesthesia protects against perioperative hyperglycemia in patients undergoing hip arthroplasty. J Clin Anesth. 2014;26(6):455-60. https://doi.org/10.1016/j.jclinane.2014.02.001
Hermanides J, Huijgen R, Henny CP, Mohammad NH, Hoekstra JB, Levi MM, DeVries JH. Hip surgery sequentially induces stress hyperglycaemia and activates coagulation. Neth J Med. 2009;67(6):226-9.
Hwang JS, Kim SJ, Bamne AB, Na YG. Do Glycemic Markers Predict Occurrence of Complications After Total Knee Arthroplasty in Patients With Diabetes? Clin Orthop Relat Res. 2015;473:1726-1731. https://doi.org/10.1007/s11999-014-4056-1
Jamsen E, Nevalainene PI, Eskelinen A, Kalliovalkama J, Moilanen T. Risk factors for perioperative hyperglycemia in primary hip and knee replacements. A prospective observational study of 191 patients with osteoarthritis. Acta Orthopaedica. 2015; 86 (2): 175-182. https://doi.org/10.3109/17453674.2014.987064
Kim TK, Ljunggren S, Hahn RG, Nystrom T. Insulin sensitivity and beta-cell function after carbohydrate oral loading in hip replacement surgery: a double-blind, randomised controlled clinical trial. Clin Nutr. 2014;33(3):392-8. https://doi.org/10.1016/j.clnu.2013.08.003
Ljunggren S, Nystrom T, Hahn RG. Accuracy and precision of commonly used methods for quantifying surgery-induced insulin resistance: Prospective observational study. Eur J Anaesthesiol. 2014;31(2):110-6. https://doi.org/10.1097/EJA.0000000000000017
Maradit Kremers H, Schleck CD, Lewallen EA, Larson DR, Van Wijnen AJ, Lewallen DG. Diabetes Mellitus and Hyperglycemia and the Risk of Aseptic Loosening in Total Joint Arthroplasty. J Arthroplasty. 2017;32(9S):S251-S253. https://doi.org/10.1016/j.arth.2017.02.056
Mraovic B, Suh D, Jacovides C, Parvizi J. Perioperative Hyperglycemia and Postoperative Infection after Lower Limb Arthroplasty. J Diabetes Sci Technol. 2011;5(2):412-418. https://doi.org/10.1177/193229681100500231
Pili-Floury S, Mitifiot F, Penfornis A, Boichut N, Tripart MH, Christophe JL, Garbuio P, Samain E. Glycaemic dysregulation in nondiabetic patients after major lower limb prosthetic surgery. Diabetes Metab. 2009;35(1):43-8. https://doi.org/10.1016/j.diabet.2008.06.007
Saluk J, Banos A, Hopkinson W, Rees H, Syed D, Hoppensteadt D, Abro S, Iqbal O, Fareed J. Prevalence of metabolic syndrome in patients undergoing total joint arthroplasty and relevance of biomarkers. Int Angiol. 2017;36(2):136-144.
Wang G, Long A, Zhang L, Zhang H, Yin P, Tang P. Impact of perioperative average blood-glucose level on prognosis of patients with hip fracture and diabetes mellitus. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2014;28(7):844-7. [Article in Chinese].
This work is licensed under a Creative Commons Attribution 4.0 International License.