Ayşen BAYSAN, Mehmet TERCAN, Erhan ÖZYURT, Fevziye Burcu ŞİRİN, Sadık ÖZMEN
Acta Medica Ruha - 2026;4(3):117-125
Introduction: Tourniquet application during arthroscopic knee surgery may cause ischemia-reperfusion injury, characterized by oxidative stress, inflammation, and cellular damage. Whether anesthetic technique influences these responses remains uncertain. Objective: To compare the effects of general and spinal anesthesia on biochemical markers of ischemia-reperfusion injury induced by tourniquet use in patients undergoing arthroscopic knee surgery. Methods: In this prospective randomized study, 41 patients undergoing elective arthroscopic knee surgery were assigned to spinal anesthesia (n=21) or general anesthesia (n=20). A pneumatic tourniquet was inflated to 300 mmHg. Blood samples were collected before anesthesia, before tourniquet inflation, at tourniquet release, 20 minutes after release, and 1 hour after release. Erythrocyte superoxide dismutase, catalase, glutathione, malondialdehyde, and myeloperoxidase were measured together with serum glucose, creatine kinase, and lactate dehydrogenase. Results: Baseline characteristics and operative, anesthetic, and tourniquet durations were comparable between groups. Superoxide dismutase, catalase, glutathione, and malondialdehyde levels did not differ significantly at any time point. However, myeloperoxidase levels were significantly higher in the general anesthesia group at 20 minutes and 1 hour after tourniquet release. Post-reperfusion glucose and lactate dehydrogenase levels were also significantly higher with general anesthesia, whereas creatine kinase levels were similar between groups. Conclusion: Tourniquet-induced ischemia of approximately 40 minutes did not significantly alter major antioxidant defenses or lipid peroxidation, regardless of anesthetic technique. However, spinal anesthesia was associated with lower levels of myeloperoxidase, glucose, and lactate dehydrogenase, suggesting reduced early inflammatory and metabolic stress compared with general anesthesia. Further large-scale randomized studies are warranted.
