Bagry Hema, de la Cuadra Fontaine Juan Carlos, Asenjo Juan Francisco, Bracco David, Carli Franco
Department of Anesthesia, McGill University Health Centre, Montreal, Quebec, Canada.
Reg Anesth Pain Med. 2008 Jan-Feb;33(1):17-23. doi: 10.1016/j.rapm.2007.06.398.
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.
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.
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.
Continuous lumbar plexus and sciatic nerve blocks with ropivacaine contribute to the attenuation of the postoperative inflammatory response.
动物实验性神经阻滞可抑制炎症反应。本研究旨在确定对膝部所有传入和传出神经纤维进行48小时局部麻醉阻滞对术后炎症反应的影响程度。
12例行初次全膝关节置换术的患者接受脊髓麻醉，然后随机分为两组，一组为吗啡患者自控镇痛（n = 6），另一组为0.2%罗哌卡因连续腰丛和坐骨神经阻滞（连续外周神经阻滞；CPNB）48小时。在手术前以及手术切口后3、8、24和48小时采集血样，以测量血浆葡萄糖、血清胰岛素和皮质醇、C反应蛋白、白细胞介素-6以及白细胞计数。记录静息和膝关节屈曲时的疼痛视觉模拟评分，并对并发症进行分类。
CPNB组在术后第1天和第2天静息和膝关节屈曲时的视觉模拟评分较低（P < .05）。葡萄糖、胰岛素和皮质醇的循环水平无差异。CPNB组的C反应蛋白和白细胞计数较低（P < .05）。白细胞计数峰值与炎症标志物之间存在正相关（P < .03）。患者自控镇痛组有3例患者，CPNB组有1例患者出现需要保守治疗的并发症。
罗哌卡因连续腰丛和坐骨神经阻滞有助于减轻术后炎症反应。
