Spinal anesthesia protects against perioperative hyperglycemia in patients undergoing hip arthroplasty ★

Study ObjectiveTo determine whether spinal anesthesia blunts surgical stress reactions and results in less perioperative hyperglycemia.DesignProspective, randomized controlled study.SettingOperating room of a university hospital.Patients68 adult, nondiabetic (n=40) and diabetic (n=28), ASA physical status 1, 2, and 3 patients patients undergoing elective total hip replacement.InterventionsGeneral or spinal anesthesia was administered.MeasurementsBlood HbA1C was measured preoperatively to identify patients with undiagnosed diabetes. Glucose levels were checked preoperatively, then immediately after, and one hour after surgery. A conventional glucose control protocol was used, where insulin was given when blood glucose concentrations exceeded 250 mg/dL.Main ResultsPreoperative glucose levels in general and spinal anesthesia patients were comparable and not significantly different in nondiabetic and diabetic patients. At the end of surgery and one hour after surgery, glucose levels were significantly higher in patients undergoing general anesthesia compared with baseline values in both diabetic and nondiabetic patients (P < 0.05). In nondiabetic and diabetic patients, a significant increase in glucose level was found in patients undergoing general anesthesia versus spinal anesthesia (P < 0.05). In patients receiving spinal anesthesia, glucose levels remained stable. Two diabetic patients undergoing general anesthesia received insulin.ConclusionSpinal anesthesia attenuates the hyperglycemic response to surgical stimuli in diabetics and nondiabetic patients.