Kuchálik J, Magnuson A, Tina E, Gupta A
Department of Anesthesiology and Intensive Care, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.
BMC Anesthesiol. 2017 May 3;17(1):63. doi: 10.1186/s12871-017-0354-y.
Postoperative inflammation following total hip arthroplasty (THA) can lead to delayed mobilization and return of hip function. Our primary aim was to assess whether local infiltration analgesia (LIA) during surgery can prevent postoperative inflammation.
This is a sub-analysis of data from a broader double-blind study where 56 patients received spinal anaesthesia for THA. Additionally, Group FNB (Femoral Nerve Block) received an ultrasound-guided femoral nerve block using 30 mL of ropivacaine 7.5 mg/mL (225 mg), and 151.5 mL of saline peri-articularly intra-operatively. Group LIA received 30 mL saline in the femoral nerve block and ropivacaine 2 mg/mL, 300 mg (150 mL) + ketorolac 30 mg (1 mL) + adrenaline 0.5 mg (0.5 mL) peri-articularly. After 23 h, the LIA mixture (22 mL) was injected via a catheter placed peri-articularly in Group LIA and 22 mL saline in Group FNB. A battery of pro- and anti-inflammatory cytokines was assessed using a commercially available kit preoperatively and after 4 h and 3 days postoperatively. Additionally, CRP, platelet count and white blood count was determined pre- and postoperatively.
There was a general trend towards an increase in pro-inflammatory cytokines postoperatively, which returned to normal levels after 3 days. IL-6 concentration was significantly lower 4 h postoperatively in Group LIA compared to Group FNB (p = 0.015). No other significant differences were found between the groups in other cytokines. CRP levels were significantly higher in Group FNB compared to Group LIA 3 days postoperatively (p < 0.001). No other significant differences were seen between the groups.
Local infiltration analgesia has a modest but short-lasting effect on postoperative inflammation in patients undergoing total hip arthroplasty. This is likely to be due to local infiltration of ketorolac and/or local anaesthetics in the LIA mixture. Future studies should be directed towards assessing whether the use of LIA translates into better patient outcomes.
EudraCT Number 2012-003875-20 . Registered 3 December 2012.
全髋关节置换术（THA）后的术后炎症可导致活动延迟和髋关节功能恢复延迟。我们的主要目的是评估手术期间局部浸润镇痛（LIA）是否能预防术后炎症。
这是一项对来自一项更广泛的双盲研究数据的亚分析，其中56例患者接受了THA的脊髓麻醉。此外，FNB组（股神经阻滞组）在术中接受了超声引导下的股神经阻滞，使用30 mL浓度为7.5 mg/mL的罗哌卡因（225 mg）以及151.5 mL生理盐水进行关节周围注射。LIA组在股神经阻滞时接受30 mL生理盐水，并在关节周围注射2 mg/mL的罗哌卡因300 mg（150 mL）+酮咯酸30 mg（1 mL）+肾上腺素0.5 mg（0.5 mL）。23小时后，LIA组通过置于关节周围的导管注射LIA混合液（22 mL），FNB组注射22 mL生理盐水。术前以及术后4小时和3天时，使用市售试剂盒评估一系列促炎和抗炎细胞因子。此外，在术前和术后测定CRP、血小板计数和白细胞计数。
术后促炎细胞因子总体呈上升趋势，3天后恢复至正常水平。与FNB组相比，LIA组术后4小时IL-6浓度显著降低（p = 0.015）。在其他细胞因子方面，两组之间未发现其他显著差异。术后3天，FNB组的CRP水平显著高于LIA组（p < 0.001）。两组之间未观察到其他显著差异。
局部浸润镇痛对全髋关节置换术患者的术后炎症有适度但持续时间较短的影响。这可能是由于LIA混合液中酮咯酸和/或局部麻醉剂的局部浸润所致。未来的研究应致力于评估LIA的使用是否能转化为更好的患者预后。
欧洲临床试验数据库编号2012-003875-20。于2012年12月3日注册。
