Comparative study of intraoperative blood glucose levels in patients undergoing elective cesarean section: Spinal versus general anesthesia – a prospective observational study

Abstract

Background: Anesthesia and surgery trigger a neuroendocrine stress response that elevates blood glucose through catecholamine and cortisol secretion. The choice of anesthetic technique significantly influences this metabolic response, particularly in obstetric patients undergoing cesarean section. Aims and Objectives: This study aimed to compare intraoperative blood glucose levels and hemodynamic parameters between spinal anesthesia (SA) and general anesthesia (GA) in patients undergoing elective lower-segment cesarean section (LSCS). Materials and Methods: A prospective observational study was conducted at a tertiary care center over 2 years (2023–2025). A total of 100 American Society of Anesthesiologists Grade II full-term pregnant patients undergoing elective LSCS were enrolled and divided into two groups of 50 each (SA group and GA group). Capillary blood glucose (CBG) and hemodynamic parameters (heart rate [HR], systolic blood pressure [SBP], diastolic blood pressure [DBP], and SpO2) were recorded at 6 time points: Baseline, after induction, at skin incision, after placental delivery, after uterine closure, at skin closure, and 15 min post-procedure/extubation. Results: Baseline parameters were comparable between groups (P>0.05). Following induction, CBG was significantly higher in the GA group (91.84 mg/dL vs. 84.94 mg/dL; P<0.05). This difference widened progressively: At skin incision (95.60 vs. 83.96 mg/dL), after placental delivery (94.56 vs. 83.04 mg/dL), and at 15 min post-procedure (96.46 vs. 81.72 mg/dL), all statistically significant (P<0.05). Hemodynamic parameters, including HR, SBP, and DBP, were also significantly higher in the GA group at all intraoperative time points. Conclusion: SA more effectively attenuates the surgical stress response compared to GA in elective cesarean section, as evidenced by lower intraoperative blood glucose levels and more stable hemodynamics. SA should be preferred for elective LSCS, particularly in metabolically vulnerable patients.