INFLUENCE OF DIFFERENT METHODS OF ANESTHETIC MANAGEMENT ON THE DYNAMICS OF STRESS AND INFLAMMATORY RESPONSE INDICATORS IN FEMALE PATIENTS UNDERGOING ABDOMINAL HYSTERECTOMY

Surgical trauma triggers a complex cascade of neuroendocrine and immune-inflammatory responses that serve adaptive functions for maintaining homeostasis. However, excessive or dysregulated activation of these mechanisms may result in metabolic disturbances, impaired tissue repair, heightened postoperative pain, elevated risks of infectious and thrombotic complications, and delayed patient recovery. The aim of the study was to compare the effects of three anesthetic techniques—multimodal low-opioid general anesthesia (MLGA), spinal anesthesia with bupivacaine (SAB), and adjuvant spinal anesthesia (ASA)—on stress response and inflammatory markers in female patients undergoing abdominal hysterectomy. Materials and Methods. The study enrolled 96 female patients, with serial measurements of cortisol, glucose, general immune parameters, and cytokines (IL-6 and IL-10) performed at different surgical stages and during early postoperative care. The investigation complied with fundamental bioethical principles outlined in the Declaration of Helsinki for medical research involving human subjects. The Biomedical Ethics Committee of Shupyk National Healthcare University of Ukraine approved the research protocol (No. 1, January 9, 2023). This work aligned with the university's scientific priorities in "Development of innovative anesthesia and intensive care techniques" (State Registration No. 0119U101724, 2019-2023). According to the anesthetic technique employed, patients were randomly allocated to three study groups: Group 1 (MLOGA; n=32): multimodal low-opioid general anesthesia; Group 2 (SAB; n=30): spinal anesthesia with 16 mg hyperbaric bupivacaine + propofol sedation Group 3 (ASA; n=34): adjuvant spinal anesthesia comprising intrathecal administration of 16 mg bupivacaine + 100 μg morphine + 20 μg fentanyl + and 4 mg dexamethasone, with dexmedetomidine infusion for sedation. The research was conducted in accordance with the fundamental principles of bioethics. Data analysis was performed using Statistica for Windows 14.0 software package (TIBCO Software Inc., Palo Alto, CA, USA). The work was carried out in accordance with the main directions of scientific and experimental work of the P. L. Shupyk National Medical Academy of Postgraduate Education of Ukraine ‘Development of innovative techniques of anaesthesia and intensive care’ (state registration number: 0119U101724, completion date: 2019–2023). Results. Neuraxial anesthesia techniques, particularly ASA with dexmedetomidine sedation, demonstrated superior efficacy in attenuating the endocrine-metabolic stress response, reducing stress-induced hyperglycemia incidence, and preserving immune function parameters compared to MLOGA. The MLOGA group exhibited the least favorable outcomes, with significantly elevated cortisol levels, persistent hyperglycemia, and highest leukocyte intoxication indices. Conversely, the ASA group showed optimal performance across all measured biomarkers Conclusion. Adjuvant spinal anesthesia incorporating dexmedetomidine provides comprehensive stress response modulation and optimal homeostasis maintenance during abdominal hysterectomy procedures, establishing it as the preferred anesthetic strategy for this surgical population.