Does Anaesthesia Affect the Stress Response after Total Hip Arthroplasty?

Abstract

A surgical intervention such as total hip arthroplasty, triggers a complex stress response in the body, involving metabolic, neuroendocrine and inflammatory reactions that influence postoperative recovery. This study aimed to compare the perioperative cortisol response and early postoperative pain in patients undergoing THA under general anaesthesia (GA) versus spinal anaesthesia (SA). This study was conducted from October 2020 to June 2024 at the Clinic of Orthopedics and Traumatology in “Tsaritsa Yoanna” – ISUL University Hospital, and included two groups of patients: Group 1 (n = 30, GA) receiving general anaesthesia and Group 2 (n = 30, SA) receiving spinal anaesthesia. The examined parameters were: serum cortisol levels (reference values 4.3–22.4 ug/dl) at four time points preoperatively, 30 min after the surgical incision, 1 h after the end of surgery, and 24 h postoperatively. Pain intensity was assessed on days 1, 2, and 3 at rest using the VAS (Visual Analogue Scale). The results show that the patients in Group 1 (GA) had higher cortisol levels 30 min after the surgical incision, 1 h postoperatively, and 24 h after surgery, compared to the SA group, with the difference being statistically significant (p < 0.001). At 24 h postoperatively, cortisol levels in Group 1 showed a trend toward normalization but remained higher than in Group 2. Pain scores on the day of surgery were significantly higher in the general anaesthesia (GA) group. However, on the second and third postoperative day, pain levels in both groups normalized and the differences became statistically insignificant. The results of our study indicate that the choice of anaesthesia significantly affects the stress response and pain in patients undergoing hip joint surgery. Cortisol measurement analysis suggests a pronounced attenuation of stress response in patients with spinal anaesthesia undergoing this kind of surgery.