Department of Anaesthesiology, Josip Juraj Strossmayer University of Osijek, University Hospital Osijek, Reanimatology and Intensive Care, Osijek, Croatia.
Department of Surgery, Josip Juraj Strossmayer University of Osijek, University Hospital Osijek, Osijek, Croatia.
Reg Anesth Pain Med. 2019 Jan;44(1):59-68. doi: 10.1136/rapm-2018-000023.
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).
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.
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).
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.
NCT02848599.
研究术后应用布比卡因或吗啡对全身炎症反应和白细胞介素（IL）-6 血浆浓度的可能影响，并确定炎症反应的强度是否与术后认知功能障碍（POCD）有关。
这是一项在学术医院进行的随机、前瞻性、对照研究。患者为 2016 年 7 月至 2017 年 9 月接受股骨骨折固定术的 65 岁及以上患者。通过 4 次采血（麻醉前、术后 24 小时、72 小时和 120 小时）检测白细胞、中性粒细胞、C 反应蛋白（CRP）和纤维蛋白原水平，通过 3 次采血（麻醉前、术后 24 小时和 72 小时）检测 IL-6 浓度，评估炎症反应。采用简易精神状态检查表（MMSE）于术前、术后第 1 天至第 5 天和出院当天评估认知功能。
本研究共纳入 70 例患者，每组 35 例。布比卡因组 POCD 的发生率（9%）明显低于吗啡组（31%）（p=0.03）。术后 72 小时（p=0.03）和 120 小时（p=0.04），布比卡因组 CRP 明显降低。术后 72 小时，布比卡因组 IL-6 值明显降低（p=0.02）。所有患者 POCD 的唯一预测因子是术后 72 小时的 IL-6 水平（p=0.03）。
在所有患者中，使用硬膜外布比卡因与一些炎症标志物的降低存在统计学显著关联。与静脉吗啡镇痛相比，术后患者自控硬膜外镇痛可降低研究人群 POCD 的发生率。
NCT02848599。
