Praveen Kumar, G (2016) A prospective randomized controlled study comparing the serum cortisol levels in patients administered general anaesthesia versus supraclavicular brachial plexus block for upper limb surgeries. Masters thesis, ESIC Medical College & Postgraduate Institute of Medical Science and Research, Chennai.
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Abstract
BACKGROUND: Surgery is a stressful condition. It is associated with increased levels of catabolic hormones. The type of anesthesia has a great influence on the stress response. In general anesthesia, though the patient is paralysed the hypothalamus still receives signals from the surgical site, which results in activation of stress response. In regional anesthesia on the other hand there is complete blockade of impulses reaching the hypothalamus resulting in decreased activation of stress response. Ill effects of stress response include increased oxygen consumption, catabolism and altered immune functions. The adverse effects are associated with poor post operative course and clinical outcome. Cortisol is the most sensitive marker for stress response. AIM OF THE STUDY: To compare the serum cortisol levels in patients administered general anesthesia versus supraclavicular brachial plexus block for upper limb surgeries METHODS: This study is a prospective randomized controlled study. The study involved 62 patients, 1 patient was excluded from the study due to lysis of blood sample. The remaining 61 patients were divided into two groups, Group GA under general anesthesia with 30 patients and Group RA under supraclavicular brachial plexus block with 31 patients. In both the groups blood samples were taken at baseline, 30 minutes after skin incision, 3 hours after skin incision and 24 hours after skin incision for cortisol evaluation . RESULTS: The preoperative cortisol levels in both the groups were comparable with P value of 0.398. At ½ hour the cortisol in Group RA was 4.30±1.59 mcg/ dl, in group GA was 23.32±14.71 mcg/dl. The cortisol values at 3 hours in group RA was 3.87±1.49 mcg/dl, in group GA was 21.16 ±12.75 mcg/ dl. The cortisol values at ½ hour and 3 hour was significantly low in Group RA when compared to Group GA with P value of 0.0001 in both the times. At 24 hours the cortisol values were comparable between the two groups with P value of 0.123. CONCLUSION: From this study it was concluded that Cortisol levels at ½ hour and 3 hours after skin incision was significantly lower in Group RA when compared to Group GA. So the magnitude of stress response was significantly lower in RA group when compared to GA group as indicated by the cortisol level. So it can be concluded that supraclavicular brachial plexus block is better than general anesthesia for upper limb surgeries due to decreased stress response as indicated by the cortisol levels.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Cortisol ; Stress Response ; Supraclavicular Brachial Plexus Block ; General Anesthesia. |
| Subjects: | MEDICAL > Anaesthesiology |
| Depositing User: | Punitha K |
| Date Deposited: | 15 Jun 2018 17:06 |
| Last Modified: | 15 Jun 2018 17:06 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/8490 |
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