Anesthetic support reducing surgical stress response in redo hip replacement for periprosthetic infection

Objective. To evaluate the effect of combined spinal-epidural anesthesia and additional immune enteral nutrition on pain syndrome and surgical stress response in redo hip replacement for periprosthetic infection. Material and methods. An open prospective randomized simple blind trial included 100 patients who underwent redo hip replacement for periprosthetic infection: group 1 (n=28) — general anesthesia with sevoflurane, no additional nutrition; group 2 (n=36) — combined spinal-epidural anesthesia, no additional nutrition; group 3 (n=36) — combined spinal-epidural anesthesia with additional enteral nutrition (500 ml) 3 days before surgery for 10 days. VAS scores of pain syndrome were assessed in 1, 3, 5 and 7 days after surgery. In all groups, serum cortisol was assessed before anesthesia, after removal of all components of prosthesis, in the morning on the 1st, 3rd, 5th and 7th days after surgery. Results. There was significantly more severe pain in group 1 compared to groups 2 and 3. Serum cortisol was lower in groups 2 and 3 during surgery (p=0.001), 1 (p=0.028), 3 (p=0.001) and 5 (p=0.016) day after surgery. In group 3, serum cortisol was lower in 3 (p=0.001) days after surgery. Conclusion. Combined spinal-epidural anesthesia and immune enteral nutrition in redo hip replacement for periprosthetic infection reduce endocrine and metabolic components of surgical stress response. Epidural analgesia in postoperative period contributes to less severe pain and lower cortisol concentrations during and after epidural anesthesia.