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

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. 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. ACTH levels were higher in Group G than Group E [Group G, t2: 71.4±39.9 pg mL(-1), t3: 578.6±566.1 pg mL(-1), Group E, t2: 20.2±16.2 pg mL(-1), t3: 56.3±73.6 pg mL(-1) (p