BACKGROUND AND OBJECTIVES: Experimental nerve block in animals inhibits the inflammatory response. The purpose of this study was to determine to what extent a 48-hour local anesthetic block of all afferent and efferent nerve fibers of the knee area has an impact on postoperative inflammatory response. METHODS:Twelve patients scheduled for primary total knee arthroplasty receivedspinal anesthesia, and then were randomly allocated to either patient-controlled analgesia with morphine (n = 6) or a combination of continuous lumbar plexus and sciatic nerve blocks (continuous peripheral nerve block; CPNB) with ropivacaine 0.2% for 48 hours. Blood samples were collected before surgery and at 3, 8, 24, and 48 hours after surgical incision to measure plasma glucose, serum insulin and cortisol, C-reactive protein, interleukin-6, and leukocyte count. Pain visual analog scale at rest and on knee flexion were recorded and complications classified. RESULTS:Visual analog scale was lower in the CPNB group at rest and on knee flexion on postoperative days 1 and 2 (P < .05). There were no differences in circulating levels of glucose, insulin, and cortisol. C-reactive protein and leukocyte count were lower in the CPNB group (P < .05). There was a positive correlation between the peak leukocyte count and the inflammatory markers (P < .03). Three patients in the patient-controlled analgesia group and one in the CPNB group had complications requiring conservative management. CONCLUSIONS: Continuous lumbar plexus and sciatic nerve blocks with ropivacaine contribute to the attenuation of the postoperative inflammatory response.
RCT Entities:
BACKGROUND AND OBJECTIVES: Experimental nerve block in animals inhibits the inflammatory response. The purpose of this study was to determine to what extent a 48-hour local anesthetic block of all afferent and efferent nerve fibers of the knee area has an impact on postoperative inflammatory response. METHODS: Twelve patients scheduled for primary total knee arthroplasty received spinal anesthesia, and then were randomly allocated to either patient-controlled analgesia with morphine (n = 6) or a combination of continuous lumbar plexus and sciatic nerve blocks (continuous peripheral nerve block; CPNB) with ropivacaine 0.2% for 48 hours. Blood samples were collected before surgery and at 3, 8, 24, and 48 hours after surgical incision to measure plasma glucose, serum insulin and cortisol, C-reactive protein, interleukin-6, and leukocyte count. Pain visual analog scale at rest and on knee flexion were recorded and complications classified. RESULTS: Visual analog scale was lower in the CPNB group at rest and on knee flexion on postoperative days 1 and 2 (P < .05). There were no differences in circulating levels of glucose, insulin, and cortisol. C-reactive protein and leukocyte count were lower in the CPNB group (P < .05). There was a positive correlation between the peak leukocyte count and the inflammatory markers (P < .03). Three patients in the patient-controlled analgesia group and one in the CPNB group had complications requiring conservative management. CONCLUSIONS: Continuous lumbar plexus and sciatic nerve blocks with ropivacaine contribute to the attenuation of the postoperative inflammatory response.
Authors: Stavros G Memtsoudis; Eduardo A Salvati; George Go; Yan Ma; Nigel E Sharrock Journal: Reg Anesth Pain Med Date: 2010 Sep-Oct Impact factor: 6.288
Authors: Alan J R Macfarlane; Govindarajulu Arun Prasad; Vincent W S Chan; Richard Brull Journal: Clin Orthop Relat Res Date: 2009-01-07 Impact factor: 4.176
Authors: Stavros G Memtsoudis; Ottokar Stundner; Daniel Yoo; Alejandro Gonzalez Della Valle; Friedrich Boettner; Anna Maria Bombardieri; Kethy Jules-Elysee; Lazaros Poultsides; Yan Ma; Thomas P Sculco Journal: Clin Orthop Relat Res Date: 2014-05 Impact factor: 4.176