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Li Y, Wulamu W, Yushan N, Guo X, Gu W, Cao L, Zhang X. Effects of Adding Morphine to Periarticular Infiltration Analgesia Combined with Single Dose Epidural Morphine in Total Knee Arthroplasty: A Randomized Controlled Study. Orthop Surg 2023; 15:1021-1027. [PMID: 36793155 PMCID: PMC10102286 DOI: 10.1111/os.13637] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 11/18/2022] [Accepted: 11/26/2022] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVE Morphine plays an important role in postoperative analgesia after total knee arthroplasty (TKA). However, there are limited data that investigate the administration ways of morphine. To evaluate the efficacy and safety of adding morphine to periarticular infiltration analgesia (PIA) combined with single-dose epidural morphine for the patients undergoing TKA. METHODS In total, 120 patients with knee osteoarthritis who underwent the primary TKA from April 2021 and March 2022 were randomized into three groups (a cocktail containing morphine with single-dose epidural morphine [Group A]; a cocktail containing morphine [Group B]; and a cocktail free of morphine [Group C]). The three groups were compared based on the Visual Analog Score at rest and during motion, requirement of tramadol, functional recovery including quadriceps strength and range of motion, and adverse events including nausea and vomiting and local and systemic adverse events. The repetitive measure analysis of variance and chi-square test among three groups were used to analyze the results. RESULTS Analgesia strategy in Group A (0.4 ± 0.8, and 0.9 ± 1.0 points, respectively) significantly reduced rest pain at 6 and 12 h after surgery relative to Group B (1.6 ± 1.2, and 2.2 ± 1.4 points, respectively) (p < 0.001), and the analgesic effect of Group B was stronger than that of Group C (2.1 ± 0.9, and 2.6 ± 0.9 points, respectively) (p < 0.05). Rest pain at 24 h after surgery was significantly lower in Group A (2.5 ± 0.8 points) and B (1.9 ± 1.0 points) than in Group C (2.5 ± 0.8) (p < 0.05). Within 24 h after surgery, the requirements for tramadol in Group A (0.25 g) and Group B (0.35 g) were significantly lower than those in Group C (0.75 g) (p < 0.05). Within 4 days of surgery, the quadriceps strength in the three groups increased gradually, and no statistical significance was noted among the three groups (p > 0.05). From the second day to the fourth day after surgery, although the three groups showed no statistical difference in the range of motion, the result of Group C was inferior to that of the other two groups. There were no significant differences in the incidence of postoperative nausea and vomiting and metoclopramide consumption among the three groups (p > 0.05). CONCLUSION PIA combined with single-dose epidural morphine effectively reduces early postoperative pain and tramadol requirement as well as few complications, which can become a safe and effective measure to improve postoperative pain after TKA.
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Affiliation(s)
- Yicheng Li
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Wuhuzi Wulamu
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Nuerailijiang Yushan
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Xiaobin Guo
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Wenchao Gu
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Li Cao
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Xiaogang Zhang
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
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Deng L, Tan L. Effects of Parecoxib Sodium Application Combined with Enhanced Recovery After Surgery Nursing on Inflammatory Factors and Knee Joint Function in Elderly Patients After Total Knee Arthroplasty. Front Surg 2022; 9:902351. [PMID: 36034381 PMCID: PMC9407036 DOI: 10.3389/fsurg.2022.902351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To study the effect of parecoxib sodium (PS) application, combined with enhanced recovery after surgery (ERAS) nursing, on inflammation and knee joint function in elderly patients after total knee arthroplasty (TKA). Methods In this prospective cross-sectional study, we recruited 120 elderly patients treated with TKA who were randomly divided into two groups, the combine group and the control group, with 60 patients in each group. Patients in the control group received ERAS nursing and normal saline, and the patients in the combine group received ERAS nursing and PS. At different times after surgery, we compared the hemoglobin (Hb), complete white blood cell count (WBC), erythrocyte sedimentation rate (ESR), and serum IL-1β, TNF-α, and IL-6, and recovery time for different ranges of joint motion and the knee joint function HSS (hospital for special surgery scale) score between the two groups. Results On the third and seventh postoperative days, the levels of Hb in the patients of the combine group were significantly lower than those in the control group (p < 0.05), while the levels of WBC, ESR, serum IL-1β, TNF-α, and IL-6 in the patients of the combine group were all significantly lower than those in the control group (p < 0.05). Compared with the patients in the control group, the recovery time for 30, 60, 90, and 120 angles of joint motion in patients of the combine group was significantly decreased (p < 0.05), and the HSS score of patients in the combine group was significantly higher than that in the control group on the first, third, and sixth postoperative months (p < 0.05). Conclusion Elderly TKA patients who received PS application, combined with ERAS nursing, had lower inflammation in peripheral blood 2 weeks after operation and faster postoperative recovery of knee joint function.
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Affiliation(s)
- Liqiong Deng
- Department of Joint Surgery, Chenzhou First People’s Hospital, Chenzhou, China
| | - Liping Tan
- Department of Nursing, Chenzhou First People’s Hospital, Chenzhou, China
- Correspondence: Liping Tan
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Choi JV, Cheung RM, Mozel MR, Merchant RN, Lee SM. Perioperative outcomes following preoperative epidural analgesia in hip fracture patients undergoing surgical repair: A systematic review. PAIN MEDICINE 2021; 23:234-245. [PMID: 34022058 DOI: 10.1093/pm/pnab176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To examine the effectiveness and safety of epidural analgesia in the presurgical period on hip fracture patients undergoing surgical repair. DESIGN Systematic review. METHODS The study protocol was registered with the PROSPERO systematic reviews register: CRD42019140396. Electronic databases were searched for randomized controlled trials comparing preoperative epidural analgesia to other forms of pain management in hip fracture patients. The primary outcomes included perioperative cardiac events and mortality. Pain, non-cardiac complications, and adverse effects were also examined as secondary outcomes. Heterogeneity of the included studies was assessed using the I2 statistic and a random-effects meta-analysis was conducted once sufficient homogeneity was demonstrated. RESULTS Four studies met the inclusion criteria, which included a total of 221 patients. Preoperative epidural analgesia resulted in fewer cardiac events, which was a reported outcome in two included studies (RR 0.30; 95% CI 0.14-0.63; I2 = 0%). Preoperative epidural analgesia was also associated with decreased perioperative mortality in a meta-analysis of two studies (RR 0.13; 95% CI 0.02-0.98; I2 = 0%). Pain was not pooled due to variability in assessment methods, but preoperative epidural analgesia was associated with reduced pain in all four studies. CONCLUSIONS Preoperative epidural analgesia for hip fracture may reduce perioperative cardiac events and mortality, but the number of included studies in this systematic review was low. More research should be done to determine the benefit of early epidural analgesia for hip fractured patients.
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Affiliation(s)
- Jonathan V Choi
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia. Orcid ID: 0000-0002-5341-2397
| | - Rachel M Cheung
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia
| | | | - Richard N Merchant
- Department of Anesthesia, Royal Columbian Hospital; Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia Orcid ID: 0000-0002-8526-2477
| | - Susan M Lee
- Department of Anesthesia, Royal Columbian Hospital; Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia Orcid ID: 0000-0001-9016-310X
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Rao PB, Mandal I, Tripathy S, Bandyopadhyay D, Tripathy S, Singh N, Panda A. Preventive Epidural Analgesia in Bilateral Single-Stage Knee Arthroplasty: A Randomized Controlled Trial. Pain Ther 2020; 9:241-248. [PMID: 31900815 PMCID: PMC7203305 DOI: 10.1007/s40122-019-00145-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Although controversial, pre-emptive analgesia has shown some promise in preventing altered pain perception and reducing pain amplification after surgery. Hence, it has the potential to be more effective than a similar analgesic regimen started after surgery with an appropriate combination of patient category and analgesic modality. Hence, the present study was undertaken to evaluate the effect of preventive epidural analgesia in reducing pain severity and duration after bilateral single-stage knee arthroplasty. METHODS Fifty patients, 18-70 years, with American Society of Anesthesiologists physical status class I & II posted for bilateral single-stage knee replacement under regional anesthesia were randomly allocated into preventive versus postoperative epidural analgesia group to compare severity of post-operative pain, analgesic consumption, day of mobilization, C-reactive protein (CRP) levels, and hospital stay. RESULTS The pain score after surgery [2.0 (1.5, 2.0); 3.0 (1.5, 3.0), p = 0.005] and day of mobilization [(2. 92 ± 0. 28; 3. 31 ± 0. 48; p value 0.02)] were significantly lesser in the preventive epidural group. However, there was no difference in the hospital stay (9.92 ± 3.71 and 9.00 ± 2.12, p = 0.95) and analgesic consumption (65.38 ± 37.55 and 73.08 ± 43.85, p = 0.30). The preventive group had a larger drop in CRP and experienced a lesser number of days with pain after surgery as compared to the controls [(64.29 ± 21.29); (142.37 ± 80.04), p = 0.0001]. Six patients in the preemptive group (24%) and 13 of the control group (24 vs. 56.5%; p = 0.02) had chronic postsurgical pain. CONCLUSIONS Preventive epidural analgesia reduces the severity and number of chronic pain days after bilateral single-stage knee replacement. TRIAL REGISTRATION The study was registered in the Indian national registry (CTRI/2017/03/008240 on 28/03/2017).
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Affiliation(s)
- Parnandi Bhaskar Rao
- Department of Anaesthesiology, All India Institute of Medical Science, Sijua, Bhubaneswar, India.
| | - Indraprava Mandal
- Department of Anaesthesiology, All India Institute of Medical Science, Sijua, Bhubaneswar, India
| | - Sujit Tripathy
- Department of Orthopaedics, All India Institute of Medical Science, Sijua, Bhubaneswar, India
| | - Debapriya Bandyopadhyay
- Department of Biochemistry, All India Institute of Medical Science, Sijua, Bhubaneswar, India
| | - Swagata Tripathy
- Department of Anaesthesiology, All India Institute of Medical Science, Sijua, Bhubaneswar, India
| | - Neha Singh
- Department of Anaesthesiology, All India Institute of Medical Science, Sijua, Bhubaneswar, India
| | - Aparajita Panda
- Department of Anaesthesiology, All India Institute of Medical Science, Sijua, Bhubaneswar, India
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Alhayyan A, McSorley S, Roxburgh C, Kearns R, Horgan P, McMillan D. The effect of anesthesia on the postoperative systemic inflammatory response in patients undergoing surgery: A systematic review and meta-analysis. Surg Open Sci 2020; 2:1-21. [PMID: 32754703 PMCID: PMC7391900 DOI: 10.1016/j.sopen.2019.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/03/2019] [Accepted: 06/06/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Surgical injury stimulates the systemic inflammatory response. The magnitude of the postoperative systemic inflammatory response has been shown to be significantly associated with short and long-term outcomes following surgery of varying severity. Different anesthetic techniques for surgery may have an impact on the postoperative systemic inflammatory response and on the rate of the postoperative infective complications.The aim of the present systematic review was to examine the relationship between perioperative anesthesia, the postoperative systemic inflammatory response and postoperative infective complications in patients undergoing surgery. METHODS This was carried out using PubMed and other established databases from 1987 up to March 2018. In particular, randomized controlled studies and systemic inflammation markers, interleukin 6 and C-reactive protein were examined. RESULTS Overall, 60 controlled, randomized clinical trials were included in the review. The mean or median values of both interleukin 6 and C-reactive protein were taken for each study and the mean value was calculated for each anesthetic group at sampling points of 12-24 and 24-72 hours for interleukin 6 and C-reactive protein respectively. When taking the magnitude of surgery into account, TIVA using propofol was significantly associated with a reduction in particular C-reactive protein (P = .04). However, there were no other specific anesthetic methods including general, regional and combined anesthetics that were associated with a reduction in either interleukin 6 or C-reactive protein. CONCLUSION There is some evidence that anesthetic regimens may reduce the magnitude of the postoperative systemic inflammatory response. However, the studies were heterogeneous and generally of low quality.Future, well conducted, adequately powered studies are required to clarify the effect of anesthesia on the postoperative systemic inflammatory response and infective complications.
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Affiliation(s)
- Aliah Alhayyan
- School of Medicine, Dentistry & Nursing - University of Glasgow, Glasgow, UK
| | - Stephen McSorley
- School of Medicine, Dentistry & Nursing - University of Glasgow, Glasgow, UK
| | - Campbell Roxburgh
- School of Medicine, Dentistry & Nursing - University of Glasgow, Glasgow, UK
| | - Rachel Kearns
- Department of Anaesthetics, School of Medicine, Dentistry & Nursing - University of Glasgow, Glasgow, UK
| | - Paul Horgan
- Institute of Cancer Sciences, School of Medicine, Dentistry & Nursing - University of Glasgow, Glasgow, UK
| | - Donald McMillan
- Institute of Cancer Sciences, Department of Surgery, School of Medicine, Dentistry & Nursing - University of Glasgow, Glasgow, UK
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Kristek G, Radoš I, Kristek D, Kapural L, Nešković N, Škiljić S, Horvat V, Mandić S, Haršanji-Drenjančević I. Influence of postoperative analgesia on systemic inflammatory response and postoperative cognitive dysfunction after femoral fractures surgery: a randomized controlled trial. Reg Anesth Pain Med 2019; 44:59-68. [PMID: 30640654 DOI: 10.1136/rapm-2018-000023] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 03/24/2018] [Accepted: 06/27/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVES To investigate the possible effect of postoperatively applied analgesics-epidurally applied levobupivacaine or intravenously applied morphine-on systemic inflammatory response and plasma concentration of interleukin (IL)-6 and to determine whether the intensity of inflammatory response is related to postoperative cognitive dysfunction (POCD). METHODS This is a randomized, prospective, controlled study in an academic hospital. Patients were 65 years and older scheduled for femoral fracture fixation from July 2016 to September 2017. Inflammatory response was assessed by leukocytes, neutrophils, C reactive protein (CRP) and fibrinogen levels in four blood samples (before anesthesia, 24 hours, 72 hours and 120 hours postoperatively) and IL-6 concentration from three blood samples (before anesthesia, 24 hours and 72 hours postoperatively). Cognitive function was assessed using the Mini-Mental State Examination preoperatively, from the first to the fifth postoperative day and on the day of discharge. RESULTS The study population included 70 patients, 35 in each group. The incidence of POCD was significantly lower in the levobupivacaine group (9%) than in the morphine group (31%) (p=0.03). CRP was significantly lower in the levobupivacaine group 72 hours (p=0.03) and 120 hours (p=0.04) after surgery. IL-6 values were significantly lower in the levobupivacaine group 72 hours after surgery (p=0.02). The only predictor of POCD in all patients was the level of IL-6 72 hours after surgery (p=0.03). CONCLUSIONS There is a statistically significant association between use of epidural levobupivacaine and a reduction in some inflammatory markers. Postoperative patient-controlled epidural analgesia reduces the incidence of POCD compared with intravenous morphine analgesia in the studied population. TRIAL REGISTRATION NUMBER NCT02848599.
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Affiliation(s)
- Gordana Kristek
- Department of Anaesthesiology, Josip Juraj Strossmayer University of Osijek, University Hospital Osijek, Reanimatology and Intensive Care, Osijek, Croatia
| | - Ivan Radoš
- Department of Anaesthesiology, Josip Juraj Strossmayer University of Osijek, University Hospital Osijek, Reanimatology and Intensive Care, Osijek, Croatia
| | - Dalibor Kristek
- Department of Surgery, Josip Juraj Strossmayer University of Osijek, University Hospital Osijek, Osijek, Croatia
| | | | - Nenad Nešković
- Department of Anaesthesiology, Josip Juraj Strossmayer University of Osijek, University Hospital Osijek, Reanimatology and Intensive Care, Osijek, Croatia
| | - Sonja Škiljić
- Department of Anaesthesiology, Josip Juraj Strossmayer University of Osijek, University Hospital Osijek, Reanimatology and Intensive Care, Osijek, Croatia
| | - Vesna Horvat
- Carolinas Pain Institute, Winston-Salem, North Carolina, USA
| | - Sanja Mandić
- Department of Clinical Laboratory Diagnostics, Josip Juraj Strossmayer University of Osijek, University Hospital Osijek, Osijek, Croatia
| | - Ivana Haršanji-Drenjančević
- Department of Anaesthesiology, Josip Juraj Strossmayer University of Osijek, University Hospital Osijek, Reanimatology and Intensive Care, Osijek, Croatia
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Vicente D, Patino M, Marcus R, Lillmoe H, Limani P, Newhook T, Lee A, Tzeng CW, Segraves-Chun Y, Tweardy D, Gottumukkala V, Vauthey JN, Aloia T, Cata JP. Impact of epidural analgesia on the systemic biomarker response after hepatic resection. Oncotarget 2019; 10:584-594. [PMID: 30728909 PMCID: PMC6355178 DOI: 10.18632/oncotarget.26549] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 12/22/2018] [Indexed: 12/30/2022] Open
Abstract
Background Perioperative inflammation is associated with poor oncologic outcomes. Regional analgesia has been shown mitigate some of these inflammatory changes and be associated with better oncologic outcomes in patients with hepatic malignancies. The mechanism for this effect, however, remains unclear. The authors sought to compare systemic biomarker concentrations in a comprehensive and oncologically relevant panel in the perioperative setting between patients undergoing thoracic epidural analgesia (TEA) and intra-venous patient- controlled analgesia (IV-PCA) for resection of hepatic metastatic disease. Results Clinicopathologic variables and baseline biomarkers were similar between TEA (n = 46) and IV-PCA (n = 16) groups. Of the biomarkers which were significantly changed from baseline, there was a lower fold change from baseline in the TEA patients compared to IV-PCA including IL-6 (13.5vs19.1), MCP-1 (1.9vs3.0), IL-8 (2.4vs3.0), and Pentraxin-3 (10.8vs15.6). Overall decreased systemic concentrations of TGFb signaling were noted in TEA patients on POD1 TGFb3 (243.2 vs. 86.0, p = 0.005), POD3 TGFb1 (6558.0 vs. 2063.3, p = 0.004), POD3 TGFb2 (468.3 vs. 368.9, p = 0.036), POD3 TGFb3 (132.2 vs. 77.8, p = 0.028), and POD5 TGFb3 (306.5 vs. 92.2, p = 0.032). POD1 IL-12p70 concentrations were significantly higher in TEA patients (8.3 vs. 1.6, p = 0.024). Conclusion Epidural analgesia damped the postoperative inflammatory response and systemic immunosuppressive signaling, as well as promoted Th1 systemic signaling early in the post-operative period after hepatic resection for metastatic disease. These differences elaborate on known mechanisms for improved oncologic outcomes with regional anesthesia, and may be considered for biomarker monitoring of effective regional anesthesia in oncologic surgery. Materials and Methods Patient data, including clinicopathologic variables were collected for this study from the database of a randomized controlled trial comparing perioperative outcomes in patients undergoing hepatic resection with TEA vs. IV-PCA. Patients undergoing resection for metastatic disease were selected for this study. Plasma concentrations (pg/mL) of well-studied biomarkers (IL-1b/2/4/5/6/7/8/10/12p70/13/17, MCP-1 IFNγ, TNFα, MIP-1b, GM-CSF, G-CSF, VEGF, Resistin, TGFb1, TGFb2, and TGFb3), as well as novel perioperative markers (CXCL12, CXCL10, Omentin-1, sLeptin R, Vaspin, Pentraxin-3, Galactin-3, FGF-23, PON-1, FGF-21) were measured preoperatively, and on postoperative day (POD)1, POD3, and POD5 using multiplex bead assays. Clinicopathologic variables and perioperative variations in these biomarkers were compared between TEA vs IV-PCA groups.
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Affiliation(s)
- Diego Vicente
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA
| | - Miguel Patino
- Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA.,Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rebecca Marcus
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Heather Lillmoe
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Preparim Limani
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Timothy Newhook
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Andy Lee
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ching-Wei Tzeng
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yun Segraves-Chun
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David Tweardy
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vijaya Gottumukkala
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Thomas Aloia
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Juan P Cata
- Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA.,Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Winsö O, Kral J, Wang W, Kralova I, Abrahamsson P, Johansson G, Blind PJ. Thoracic epidural anaesthesia reduces insulin resistance and inflammatory response in experimental acute pancreatitis. Ups J Med Sci 2018; 123:207-215. [PMID: 30468105 PMCID: PMC6327622 DOI: 10.1080/03009734.2018.1539054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
AIMS The activity of the sympathetic nervous system (SNS) is crucial at an early stage in the development of an inflammatory reaction. A study of metabolic events globally and locally in the early phase of acute pancreatitis (AP), implying hampered SNS activity, is lacking. We hypothesized that thoracic epidural anaesthesia (TEA) modulates the inflammatory response and alleviates the severity of AP in pigs. MATERIAL AND METHODS The taurocholate (TC) group (n = 8) had only TC AP. The TC + TEA group (n = 8) had AP and TEA. A control group (n = 8) underwent all the preparations, without having AP or TEA. Metabolic changes in the pancreas were evaluated by microdialysis and by histopathological examination. RESULTS The relative increase in serum lipase concentrations was more pronounced in the TC group than in TC + TEA and control groups. A decrease in relative tissue oxygen tension (PtiO2) levels occurred one hour later in the TC + TEA group than in the TC group. The maintenance of normoglycaemia in the TC group required a higher glucose infusion rate than in the TC + TEA group. The relative decrease in serum insulin concentrations was most pronounced in the TC + TEA group. CONCLUSION TEA attenuates the development of AP, as indicated by changes observed in haemodynamic parameters and by the easier maintenance of glucose homeostasis. Further, TEA was associated with attenuated insulin resistance and fewer local pathophysiological events.
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Affiliation(s)
- Ola Winsö
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care Medicine, Umeå University, Umeå, Sweden
- CONTACT Professor Ola Winsö, MD, PhD Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care Medicine, Umeå University, SE-901 85Umeå, Sweden
| | - Josef Kral
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care Medicine, Umeå University, Umeå, Sweden
| | - Wanzhong Wang
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | - Ivana Kralova
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care Medicine, Umeå University, Umeå, Sweden
| | - Pernilla Abrahamsson
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care Medicine, Umeå University, Umeå, Sweden
| | - Göran Johansson
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care Medicine, Umeå University, Umeå, Sweden
| | - Per-Jonas Blind
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
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Is epidural analgesia still a viable option for enhanced recovery after abdominal surgery. Curr Opin Anaesthesiol 2018; 31:622-629. [DOI: 10.1097/aco.0000000000000640] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Fu S, Qu PS, Cai SN. Effect of anesthetic methods on postoperative CD3 +, CD4 + and CD4 +CD25 + in patients with lung cancer undergoing radical operation. Oncol Lett 2018; 16:6547-6551. [PMID: 30344761 PMCID: PMC6176376 DOI: 10.3892/ol.2018.9416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 08/23/2018] [Indexed: 12/26/2022] Open
Abstract
Effects of anesthesia methods on immune function in patients with lung cancer undergoing radical operation were investigated. A total of 122 patients undergoing radical resection of lung cancer who were treated in Zhejiang Cancer Hospital from September 2013 to April 2016 were randomly divided into the combined anesthesia group and the intravenous anesthesia group, with 61 cases in each group. The patients in the combined anesthesia group were given intravenous combined epidural anesthesia. Patients in the intravenous anesthesia group were given intravenous anesthesia. The change of CD3+, CD4+ and CD4+CD25+ at time-point T0 (before anesthesia), T1 (the time of anesthesia), T2 (after operation), T3 (24 h after operation), T4 (72 h after operation) were compared between the two groups. The levels of CD3+, CD4+ and CD4+CD25+ at T1, T2, T3 and T4 in the combined anesthesia group were higher than that in the intravenous anesthesia group (P<0.05). Αfter starting anesthesia, the levels of CD3+, CD4+ and CD4+CD25+ began to decrease in both groups. The levels of CD3+, CD4+ and CD4+CD25+ at T2 and T1 were lower than those at T0 (P<0.05). The levels of CD3+, CD4+ and CD4+CD25+ at T2 were lower than T1 (P<0.05). After T3, the levels of CD3+, CD4+ and CD4+CD25+ began to increase in both groups. Τhe levels of CD3+, CD4+ and CD4+CD25+ at T3 and T4 were higher in both groups than those at T2 and T1 (P<0.05), and the levels of CD3+, CD4+ and CD4+CD25+ at T4 were higher in both groups than those at T3, but the levels of CD3+, CD4+ and CD4+CD25+ at T3 and T4 were lower than those at T0 (P<0.05). Intravenous combined epidural anesthesia can maintain a relatively stable immune function compared with simple intravenous anesthesia patients.
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Affiliation(s)
- Shuang Fu
- Department of Anesthesiology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, P.R. China
| | - Pi-Sheng Qu
- Department of Pain Treatment, Hospital of Integrated Traditional Chinese and Western Medicine in Zhejiang Province, Hangzhou, Zhejiang 310022, P.R. China
| | - Shu-Nv Cai
- Department of Anesthesiology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, P.R. China
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11
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Gimeno AM, Errando CL. Neuraxial Regional Anaesthesia in Patients with Active Infection and Sepsis: A Clinical Narrative Review. Turk J Anaesthesiol Reanim 2018; 46:8-14. [PMID: 30140495 DOI: 10.5152/tjar.2018.12979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 11/23/2017] [Indexed: 12/31/2022] Open
Abstract
Infection is considered to be a relative contraindication for regional anaesthesia. However, there is a paucity of articles addressing the topic of regional anaesthesia in patients with an active infectious process. Recent publications show a low incidence of infection (0.007% to 0.6%) of the central nervous system after neuraxial punctures in patients at risk of, or with ongoing bacteraemia, and a low incidence of infection after performing regional anaesthesia techniques in immunosuppressed patients, or patients with an actual infection. Therefore, some authors conclude that it seems that there is little justification to set strict contraindications regarding this indication and that the risk-benefit ratio should prevail. In addition, a low incidence of meningitis or abscesses after the lumbar puncture has been observed in patients with unsuspected and ongoing bacteraemia, or who were at risk of bacteraemia, when antibiotic therapy has been previously started. For viral infections, regional techniques seem to be safe, being applied in patients with HIV infection. The only established absolute contraindication for any type of regional anaesthesia technique is the infection at the puncture site. Debate persists if a neuraxial anaesthesia technique is to be performed in the course of sepsis with the origin away from the puncture site. In case of thoracic epidural anaesthesia and analgesia, experimental and clinical studies highlight their potential benefits in the systemic inflammatory response syndromes and founded sepsis, both in surgical and non-surgical patients. Finally, the anti-inflammatory and anti-infective effects of local anaesthetics and the basis of excessive inflammatory response are described, as the latter might be involved, in part, in the clinical outcomes.
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12
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Brumnjak SV, Rakovac I, Kinkela DP, Bukal K, Sestan B, Tulic V, Janjetic EV, Tokmadzic VS. Postoperative Regional Analgesia Is Effective in Preserving Perforin-Expressing Lymphocytes in Patients After Total Knee Replacement. Med Sci Monit 2018; 24:5320-5328. [PMID: 30063033 PMCID: PMC6083937 DOI: 10.12659/msm.909385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/18/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Pain and surgical stress cause a pro-inflammatory response followed by downregulation of the immune response, which can increase the incidence of postoperative complications, such as infections or prolonged wound healing. T lymphocytes and natural killer (NK) cells have cytotoxic potential and are crucial components of cellular immunity, which is important for maintenance of immune balance. The aim of this study was to analyze the effects of 3 types of postoperative analgesia on the preservation and cytotoxic potential of T lymphocytes, NK cells, and their subpopulations, as well as NKT cells, in patients after total knee replacement (TKR) to find the most effective analgesic technique for mitigating immune suppression. MATERIAL AND METHODS Forty-eight patients scheduled for TKR were randomly allocated to Group 1 (patients received epidural analgesia), Group 2 (patients received sciatic and femoral nerve block), or Group 3 (patients received multimodal systemic analgesia). Pain intensity was assessed at rest and on movement before, immediately after, and at 24 and 72 h after surgery. Blood samples were collected at the same time points and peripheral blood mononuclear cells were isolated. The frequencies of T lymphocytes, NK cells, and NKT cells, as well as their perforin expression, were simultaneously detected and analyzed by flow cytometry. RESULTS Patients in Group 1 and Group 2 experienced less severe pain than those in Group 3. The frequencies and perforin levels of T lymphocytes, their subsets, and NKT cells were significantly lower in Group 3 than in Group 1 and Group 2. CONCLUSIONS The present study confirmed that regional analgesia is more effective in maintaining cell-mediated immunity and perforin expression in peripheral blood lymphocytes in patients after TKR.
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Affiliation(s)
- Sandra Velcic Brumnjak
- Department of Anesthesiology and Intensive Care Medicine, Clinic for Orthopedic and Traumatology Lovran, Lovran, Croatia
| | - Ivan Rakovac
- Department of Orthopedics and Traumatology, Clinic for Orthopedic and Traumatology Lovran, Lovran, Croatia
| | - Dijana Papez Kinkela
- Department of Anesthesiology and Intensive Care Medicine, Clinic for Orthopedic and Traumatology Lovran, Lovran, Croatia
| | - Kresimir Bukal
- Department of Anesthesiology and Intensive Care Medicine, Clinic for Orthopedic and Traumatology Lovran, Lovran, Croatia
| | - Branko Sestan
- Department of Orthopedics and Traumatology, Clinic for Orthopedic and Traumatology Lovran, Lovran, Croatia
| | - Vera Tulic
- Department of Anesthesiology and Intensive Care Medicine, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Elisa Velcic Janjetic
- Department for Mathematics, Physics, Foreign Languages, and Kinesiology, Faculty of Engineering, University of Rijeka, Rijeka, Croatia
| | - Vlatka Sotosek Tokmadzic
- Department of Anesthesiology, Reanimatology, and Intensive Care Medicine, Faculty of Medicine, Rijeka, Croatia
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13
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Postoperative Myocardial Injury and Inflammation Is Not Blunted by a Trial of Atorvastatin in Orthopedic Surgery Patients. HSS J 2018; 14:67-76. [PMID: 29398998 PMCID: PMC5786589 DOI: 10.1007/s11420-017-9577-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 08/16/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Orthopedic patients are at risk for adverse postoperative cardiovascular outcomes. QUESTIONS/PURPOSES This pilot randomized controlled trial (RCT) of atorvastatin vs. placebo in orthopedic surgery patients was performed in order to assess: (1) the prevalence of perioperative myocardial injury; (2) the effect of atorvastatin on perioperative inflammation; and (3) the feasibility of performing a large RCT of statin therapy in orthopedic patients. METHODS Hip fracture (hip Fx) and total hip and knee replacement (THR and TKR) patients were randomized 1:1 to atorvastatin 40 mg daily vs. placebo, starting preoperatively and continuing until postoperative day (POD) 45. High-sensitivity cardiac troponin I (hs-cTnI), high-sensitivity C-reactive protein (hs-CRP), and interleukin-6 (IL-6) were measured preoperatively and on POD 2. Patients were monitored for adverse events until POD 90. RESULTS Five hundred fifty-six patients were screened, 22 were recruited (4 hip Fx, 11 THR, 7 TKR), and 2 withdrew. Most (80%) had detectable hs-cTnI (> 1.1 pg/mL) preoperatively. Twenty percent had a perioperative rise in hs-cTnI (≥ 10 pg/mL), which was not blunted by atorvastatin. Hs-CRP rose in 19/20 patients, and IL-6 rose in all patients. However, atorvastatin did not blunt the rise in these inflammatory biomarkers. On POD 2, IL-6 and hs-cTnI levels correlated (ρ = 0.59, p = 0.02). Recruitment was limited by the high prevalence of statin use in the screened population and a high prevalence of exclusions among hip fracture patients. CONCLUSION Perioperative myocardial injury and inflammation are common in orthopedic patients and do not appear to be reduced in those randomized to atorvastatin. TRIAL REGISTRATION NCT02197065.
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14
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Soliz JM, Ifeanyi IC, Katz MH, Wilks J, Cata JP, McHugh T, Fleming JB, Feng L, Rahlfs T, Bruno M, Gottumukkala V. Comparing Postoperative Complications and Inflammatory Markers Using Total Intravenous Anesthesia Versus Volatile Gas Anesthesia for Pancreatic Cancer Surgery. Anesth Pain Med 2017; 7:e13879. [PMID: 29344445 PMCID: PMC5750426 DOI: 10.5812/aapm.13879] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/23/2017] [Accepted: 08/07/2017] [Indexed: 12/30/2022] Open
Abstract
Objectives The objective of this study is to evaluate postoperative complications and inflammatory profiles when using a total intravenous anesthesia (TIVA) or volatile gas-opioid (VO) based anesthesia in patients undergoing pancreatic cancer surgery. Methods Design, retrospective propensity score matched cohort; Setting, major academic cancer hospital; Patients, all patients who had pancreatic surgery between November 2011 and August 2014 were retrospectively reviewed. Propensity score matched patient pairs were formed. A total of 134 patients were included for analysis with 67 matched pairs; Interventions, Patients were categorized according to type of anesthetic used (TIVA or VO). Patients in the TIVA group received preoperative celecoxib, tramadol, and pregabalin in addition to intraoperative TIVA with propofol, lidocaine, ketamine, and dexmedetomidine. The VO-group received a volatile-opioid based anesthetic; Measurements, demographic, perioperative clinical data, platelet lymphocyte ratios, and neutrophil lymphocyte ratios were collected. Complications were graded and collected prospectively and later reviewed retrospectively. Results Patients receiving TIVA were more likely to have no complication or a lower grade complication than the VO-group (P = 0.014). There were no differences in LOS or postoperative inflammatory profiles noted between the TIVA and VO groups. Conclusions In this retrospective matched analysis of patients undergoing pancreatic cancer surgery, TIVA was associated with lower grade postoperative complications. Length of hospital stay (LOS) and postoperative inflammatory profiles were not significantly different.
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Affiliation(s)
- Jose M Soliz
- Department of Anesthesiology and Perioperative Medicine, Houston, TX, USA
- Corresponding author: Jose M Soliz, MD, Department of Anesthesiology and Perioperative Medicine University of Texas M.D., Anderson Cancer Center, 1400 Holcombe Blvd, Houston, TX 77030, E-mail:
| | - Ifeyinwa C Ifeanyi
- Department of Anesthesiology and Perioperative Medicine, Houston, TX, USA
| | | | - Jonathan Wilks
- Department of Anesthesiology and Perioperative Medicine, Houston, TX, USA
| | - Juan P Cata
- Department of Anesthesiology and Perioperative Medicine, Houston, TX, USA
| | - Thomas McHugh
- Department of Anesthesiology and Perioperative Medicine, Houston, TX, USA
| | | | - Lei Feng
- Department of Biostatistics, Houston, TX, USA
| | - Thomas Rahlfs
- Department of Anesthesiology and Perioperative Medicine, Houston, TX, USA
| | - Morgan Bruno
- Department of Surgical Oncology, Houston, TX, USA
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15
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Atchabahian A, Schwartz G, Hall CB, Lajam CM, Andreae MH. Regional analgesia for improvement of long-term functional outcome after elective large joint replacement. Cochrane Database Syst Rev 2015; 2015:CD010278. [PMID: 26269416 PMCID: PMC4566967 DOI: 10.1002/14651858.cd010278.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Regional analgesia is more effective than conventional analgesia for controlling pain and may facilitate rehabilitation after large joint replacement in the short term. It remains unclear if regional anaesthesia improves functional outcomes after joint replacement beyond three months after surgery. OBJECTIVES To assess the effects of regional anaesthesia and analgesia on long-term functional outcomes 3, 6 and 12 months after elective major joint (knee, shoulder and hip) replacement surgery. SEARCH METHODS We performed an electronic search of several databases (CENTRAL, MEDLINE, EMBASE, CINAHL), and handsearched reference lists and conference abstracts. We updated our search in June 2015. SELECTION CRITERIA We included randomized controlled trials (RCTs) comparing regional analgesia versus conventional analgesia in patients undergoing total shoulder, hip or knee replacement. We included studies that reported a functional outcome with a follow-up of at least three months after surgery. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We contacted study authors for additional information. MAIN RESULTS We included six studies with 350 participants followed for at least three months. All of these studies enrolled participants undergoing total knee replacement. Studies were at least partially blinded. Three studies had a high risk of performance bias and one a high risk of attrition bias, but the risk of bias was otherwise unclear or low.Only one study assessed joint function using a global score. Due to heterogeneity in outcome and reporting, we could only pool three out of six RCTs, with range of motion assessed at three months after surgery used as a surrogate for joint function. All studies had a high risk of detection bias. Using the random-effects model, there was no statistically significant difference between the experimental and control groups (mean difference 3.99 degrees, 95% confidence interval (CI) - 2.23 to 10.21; P value = 0.21, 3 studies, 140 participants, very low quality evidence).We did not perform further analyses because immediate adverse effects were not part of the explicit outcomes of any of these typically small studies, and long-term adverse events after regional anaesthesia are rare.None of the included studies elicited or reported long-term adverse effects like persistent nerve damage. AUTHORS' CONCLUSIONS More high-quality studies are needed to establish the effects of regional analgesia on function after major joint replacement, as well as on the risk of adverse events (falls).
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Affiliation(s)
- Arthur Atchabahian
- NYU School of MedicineDepartment of Anesthesiology, Perioperative Care, and Pain MedicineNew YorkNYUSA
| | - Gary Schwartz
- Maimonides Medical CenterDepartment of Anesthesiology4802 10th AvenueBrooklynNew YorkUSA11219
| | - Charles B Hall
- Albert Einstein College of Medicine, Mazer 220ADivision of Biostatistics, Department of Epidemiology and Population Health, Saul
B Korey Department of Neurology1300 Morris Park AvenueBronxNYUSA10461
| | - Claudette M Lajam
- NYU Langone Medical CenterDepartment of Orthopedic SurgeryNew YorkNYUSA
| | - Michael H Andreae
- Montefiore Medical Center, Albert Einstein College of MedicineDepartment of Anesthesiology111E 210th Street,#N4‐005New YorkNYUSA10467‐2401
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16
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Yu B, Hu X, Zou T, He M, Cai G. Effects of Postoperative Continuous Femoral Nerve Block Analgesia with Braun Continuous Peripheral Nerve Block Catheter Set versus Novel Needle-Over-Cannula after Total Knee Arthroplasty. Med Sci Monit 2015; 21:1843-9. [PMID: 26111971 PMCID: PMC4494567 DOI: 10.12659/msm.893617] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this study was to compare the novel needle-over-cannula vs. the Braun continuous peripheral nerve block catheter set (Contiplex A) in postoperative analgesics after total knee arthroplasty (TKA). MATERIAL AND METHODS Sixty patients undergoing total knee arthroplasty were randomly assigned to Braun continuous peripheral nerve block catheter set group (Braun Group, n=30) or the novel needle-over-cannula group (Cannula Group, n=30). All the patients in the 2 groups received continuous femoral nerve block (CFNB) for postoperative analgesics. RESULTS We found no significant difference in analgesic effect between the 2 groups. The time of catheter or cannula insertion was shorter in the Cannula Group than in the Braun Group. Four (13.32%) out of 30 patients had failed catheter insertions in the Braun Group compared to none in the Cannula Group. Twelve (46%) out of 26 patients in the Braun Group had serious local anesthetic leakage at puncture sites during 12 h compared to none in the Cannula Group. CONCLUSIONS The novel needle-over-cannula is effective, convenient, and safe in CFNB after TKA.
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Affiliation(s)
- Bin Yu
- Department of Anesthesiology, Tongji Hospital, Shanghai, China (mainland)
| | - Xiaoxue Hu
- Department of Anesthesiology, Guanghua Integrated Traditional Chinese and Western Medicine Hospital, Shanghai, China (mainland)
| | - Tianxiao Zou
- Department of Anesthesiology, Tongji Hospital, Shanghai, China (mainland)
| | - Miao He
- Department of Anesthesiology, Tongji Hospital, Shanghai, China (mainland)
| | - Guangyu Cai
- Department of Anesthesiology, Tongji Hospital, Shanghai, China (mainland)
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17
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Watt DG, Horgan PG, McMillan DC. Routine clinical markers of the magnitude of the systemic inflammatory response after elective operation: a systematic review. Surgery 2015; 157:362-80. [PMID: 25616950 DOI: 10.1016/j.surg.2014.09.009] [Citation(s) in RCA: 223] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 09/08/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND Operative injury to the body from all procedures causes a stereotypical cascade of neuroendocrine, cytokine, myeloid, and acute phase responses. This response has been examined commonly by the use of cortisol, interleukin-6 (IL-6), white cell count, and C-reactive protein (CRP). We aimed to determine which markers of the systemic inflammatory response were useful in determining the magnitude of injury after elective operations. METHODS A systematic review of the literature was performed using surgery, endocrine response, systemic inflammatory response, cortisol, IL-6, white cell count, and CRP. For each analyte the studies were grouped according to whether the operative injury was considered to be minor, moderate, or major and then by the operative procedure. RESULTS A total of 164 studies were included involving 14,362 patients. The IL-6 and CRP responses clearly were associated with the magnitude of operative injury and the invasiveness of the operative procedure. For example, the peak CRP response increased from 52 mg/L with cholecystectomy to 123 mg/L with colorectal cancer resection, 145 mg/L with hip replacement, 163 mg/L after abdominal aortic aneurysm repair, and 189 mg/L after open cardiac surgery. There also appeared to be a difference between minimally invasive/laparoscopic and open procedures such as cholecystectomy (27 vs 80 mg/L), colorectal cancer resection (97 vs 133 mg/L), and aortic aneurysm repair (132 vs 180 mg/L). CONCLUSION Peak IL-6 and CRP concentrations consistently were associated with the magnitude of operative injury and operative procedure. These markers may be useful in the objective assessment of which components of Enhanced Recovery after Surgery are likely to improve patient outcome and to assess the possible impact of operative injury on immune function.
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Affiliation(s)
- David G Watt
- Academic Unit of Colorectal Surgery, School of Medicine-University of Glasgow, Glasgow Royal Infirmary, Glasgow, Scotland.
| | - Paul G Horgan
- Academic Unit of Colorectal Surgery, School of Medicine-University of Glasgow, Glasgow Royal Infirmary, Glasgow, Scotland
| | - Donald C McMillan
- Academic Unit of Colorectal Surgery, School of Medicine-University of Glasgow, Glasgow Royal Infirmary, Glasgow, Scotland
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18
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Li Y, Hu C, Fan Y, Wang H, Xu H. Epidural analgesia with amide local anesthetics, bupivacaine, and ropivacaine in combination with fentanyl for labor pain relief: a meta-analysis. Med Sci Monit 2015; 21:921-8. [PMID: 25816849 PMCID: PMC4395021 DOI: 10.12659/msm.892276] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The study compares the effectiveness of bupivacaine and fentanyl (BUPI-FEN) and ropivacaine and fentanyl (ROPI-EFN) in epidural analgesia for labor pain through a meta-analysis of relevant randomized clinical trials. Material/Methods Multiple electronic databases were searched using appropriate MeSH terms and keywords for original English language research papers published between 1990 and March 2014. Meta-analyses results were based on the mean differences between the groups as well as odds ratios where appropriate. Statistical heterogeneity amongst the included studies was tested by I2 index. Results Nine studies that met the inclusion criteria were selected for analysis which consisted of 556 parturient patients. The duration of the second stage of labor was significantly shorter in the BUPI-FEN group by a mean of −6.87 (−10.98, −2.77; P<0.002). On the other hand, the ROPI-FEN group had a significantly lower incidence of motor blockade by a mean of 0.31 (0.18, 0.51; P<0.00001). A positive relationship between the amide local anesthetic concentration and the number of women having motor blockade was observed, but a negative relationship between fentanyl concentration and the number of women experiencing a motor block. Moreover, a positive correlation was found between the concentration of ropivacaine and the incidence of instrumental delivery and between the concentration of bupivacaine and the incidence of cesarean delivery. Conclusions In combination with fentanyl, bupivacaine and ropivacaine exhibit comparable efficacy and safety. However, BUP-FEN analgesia led to a shortened second-stage labor and ROPI-FEN resulted in a significantly lower incidence of motor block.
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Affiliation(s)
- Yiyang Li
- Department of Gynecology, First Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Cong Hu
- Center of Reproductive Medicine, First Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Yanyan Fan
- Department of Gynecology, First Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Huixia Wang
- Department of Anesthesiology, Jinan General Hospital, PLA Jinan Military Area Command, Jinan, Shandong, China (mainland)
| | - Hongmei Xu
- Department of Obstetrics, First Hospital of Jilin University, Changchun, Jilin, China (mainland)
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19
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Igarashi T, Suzuki T, Mori K, Inoue K, Seki H, Yamada T, Kosugi S, Minamishima S, Katori N, Sano F, Abe T, Morisaki H. The effects of epidural anesthesia on growth of Escherichia coli at pseudosurgical site: the roles of the lipocalin-2 pathway. Anesth Analg 2015; 121:81-89. [PMID: 25782996 DOI: 10.1213/ane.0000000000000694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Neutrophil-derived lipocalin-2 exerts bacteriostatic effects through retardation of iron uptake by the Gram-negative organisms like Escherichia coli. We tested the hypothesis that the expression of lipocalin-2, a bacteriostatic protein, was upregulated by induction of surgical site infection (SSI) with E coli in healthy and diseased rats and that epidural anesthesia modulated its expression. METHODS Male Wistar rats were randomized into a healthy or disease group, the latter of which was administered lipopolysaccharide. Both groups were further divided into 3 subgroups, the control, saline, and lidocaine groups: group healthy control (n = 10), healthy saline (n = 10), and healthy lidocaine (n = 10) versus group disease control (n = 15), disease saline (n = 18), and disease lidocaine (n = 19), respectively. While saline was epidurally administered to the control and saline groups, lidocaine was administered to the lidocaine groups. Except for the control groups, E coli was injected to the pseudosurgical site to mimic SSI after abdominal surgery. Plasma concentrations of inflammatory cytokine and lipocalin-2 were measured. At 72 hours, the surgical site tissues were obtained to evaluate mRNA expression of lipocalin-2 and E coli DNA expression. RESULTS All disease subgroups showed markedly increased plasma inflammatory cytokines versus the healthy subgroups. Among the disease subgroups, plasma concentrations of lipocalin-2 and tissue mRNA expression of lipocalin-2 were significantly increased in group disease lidocaine versus the others. Concurrently, E coli DNA expression in the tissue specimens was also significantly lower in group disease lidocaine as compared with group disease saline. CONCLUSIONS Epidural anesthesia was associated with an increase in the expression lipocalin-2 and a decrease in the expression of E coli DNA at pseudosurgical sites in sick but not healthy rats. These observations suggest a potential mechanism by which epidural anesthesia could reduce the risk of SSI.
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Affiliation(s)
- Toru Igarashi
- From the Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan; Center for Clinical Research, Keio University School of Medicine, Tokyo, Japan; and Department of Preventive Medicine and Public Health, Center for Clinical Research, Keio University School of Medicine, Tokyo, Japan
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Abstract
This paper is the thirty-sixth consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2013 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior, and the roles of these opioid peptides and receptors in pain and analgesia; stress and social status; tolerance and dependence; learning and memory; eating and drinking; alcohol and drugs of abuse; sexual activity and hormones, pregnancy, development and endocrinology; mental illness and mood; seizures and neurologic disorders; electrical-related activity and neurophysiology; general activity and locomotion; gastrointestinal, renal and hepatic functions; cardiovascular responses; respiration and thermoregulation; and immunological responses.
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY 11367, United States.
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21
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Milosavljevic SB, Pavlovic AP, Trpkovic SV, Ilić AN, Sekulic AD. Influence of spinal and general anesthesia on the metabolic, hormonal, and hemodynamic response in elective surgical patients. Med Sci Monit 2014; 20:1833-40. [PMID: 25284266 PMCID: PMC4199462 DOI: 10.12659/msm.890981] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The aim of the study was to determine the significance of spinal anesthesia in the suppression of the metabolic, hormonal, and hemodynamic response to surgical stress in elective surgical patients compared to general anesthesia. Material/Methods The study was clinical, prospective, and controlled and it involved 2 groups of patients (the spinal and the general anesthesia group) who underwent the same surgery. We monitored the metabolic and hormonal response to perioperative stress based on serum cortisol level and glycemia. We also examined how the different techniques of anesthesia affect these hemodynamic parameters: systolic arterial pressure (AP), diastolic AP, heart rate (HR), and arterial oxygen saturation (SpO2). These parameters were measured before induction on anesthesia (T1), 30 min after the surgical incisions (T2), 1 h postoperatively (T3) and 24 h after surgery (T4). Results Serum cortisol levels were significantly higher in the general anesthesia group compared to the spinal anesthesia group (p<0.01). Glycemia was significantly higher in the general anesthesia group (p<0.05). There was a statistically significant, positive correlation between serum cortisol levels and glycemia at all times observed (p<0.01). Systolic and diastolic AP did not differ significantly between the groups (p=0.191, p=0.101). The HR was significantly higher in the general anesthesia group (p<0.01). SpO2 values did not differ significantly between the groups (p=0.081). Conclusions Based on metabolic, hormonal, and hemodynamic responses, spinal anesthesia proved more effective than general anesthesia in suppressing stress response in elective surgical patients.
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Affiliation(s)
| | - Aleksandar P Pavlovic
- Department of Surgery, Medical Faculty, University of Pristina, Kosovska Mitrovica, Serbia
| | - Sladjana V Trpkovic
- Department of Surgery, Medical Faculty, University of Pristina, Kosovska Mitrovica, Serbia
| | - Aleksandra N Ilić
- Department of Preventive Medicine, Medical Faculty, University of Pristina, Kosovska Mitrovica, Serbia
| | - Ana D Sekulic
- Department of Anesthesiology, CHC "Bezanijska Kosa", Belgrade, Serbia
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22
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Salman N, Durukan AB, Gurbuz HA, Yamalı H, Guler L, Ucar HI, Yorgancioglu C. Comparison of effects of epidural bupivacaine and intravenous meperidine analgesia on patient recovery following elective abdominal aortic surgery. Med Sci Monit 2013; 19:347-52. [PMID: 23666275 PMCID: PMC3659110 DOI: 10.12659/msm.889005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background The efficacy of epidural anesthesia and analgesia in management of perioperative stress has been established. Perioperative pain management strategies decrease surgical complications and aid recovery. In this study, we aimed to document and compare the efficacy of epidural bupivacaine and intravenous meperidine on recovery of patients with elective abdominal aortic surgery performed under general anesthesia. Material/Methods Patients undergoing elective abdominal aortic surgery between February 2009 and November 2011 were studied prospectively. Patients were randomized into epidural bupivacaine (n=40) and intravenous meperidine (n=40) groups regarding postoperative analgesia strategy. The preoperative demographic characteristics, perioperative outcomes, postoperative adverse effects of analgesia strategy, time to initiate oral intake, sedation scores, visual analogue scale results, and mobility scores were compared. Results The mean ages of the patients were 61.7±8.1 in the epidural group and 59.4±9.7 in the intravenous group (p>0.05). The preoperative demographic characteristics of the patients were comparable between the groups. There were no statistically significant differences between groups regarding anesthesia times, intubation times, intensive care unit stay, hospital length of stay, postoperative vomiting, and postoperative cardiac, renal, and cerebral complications. Postoperative nausea was more prevalent in the meperidine group (p<0.05). In the epidural group, time to begin oral intake was shorter, sedation scores and visual analogue scale results were lower, and mobility scores were higher (p<0.05 each). Conclusions Epidural analgesia allowed earlier recovery compared to intravenous analgesia in patients undergoing elective abdominal aortic surgery, but did not affect postoperative outcomes and complications.
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Affiliation(s)
- Nevriye Salman
- Department of Anesthesia, Medicana International Ankara Hospital, Ankara, Turkey
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