Impact of Spinal Anaesthesia on Perioperative Blood Glucose Fluctuationsin Diabetic Patients Undergoing Lower Limb Orthopaedic Procedures: AProspective Study

Abstract

Background: Surgical stress and anesthesia are known to cause significant alterations in blood glucose levels,particularly in diabetic patients. Perioperative hyperglycemia is associated with increased risk of infections,delayed wound healing, and adverse outcomes. Spinal anesthesia, by attenuating the neuroendocrine stressresponse, may influence perioperative glycemic control favorably.Objectives:• To assess the effect of spinal anesthesia on perioperative blood glucose levels in diabetic patients undergoinglower limb orthopedic surgeries.• To evaluate the incidence of perioperative hyperglycemia and associated risk factors.Methods: A prospective observational study was conducted at the Department of Anesthesiology, NMCH, Patna,Bihar, India, from September 2021 to August 2022. Seventy diabetic patients scheduled for elective lower limborthopedic procedures under spinal anesthesia were enrolled. Blood glucose levels were recorded preoperatively,intraoperatively at 1-hour intervals, and postoperatively up to 6 hours. Glycemic variations were analyzed, andassociations with patient demographics, duration of surgery, and baseline glycemic control were evaluated.Results: Spinal anesthesia was associated with relative stability of intraoperative and immediate postoperativeblood glucose levels. Significant perioperative hyperglycemia (blood glucose >180 mg/dL) was observed in 24%of patients, mainly in those with poor preoperative glycemic control (HbA1c >8%). No major intraoperativehemodynamic instability or adverse outcomes were recorded.Conclusion: Spinal anesthesia helps in maintaining better perioperative glycemic stability in diabetic patientsundergoing lower limb orthopedic surgeries. Preoperative glycemic optimization remains crucial in minimizingperioperative hyperglycemia and associated complications.