Li Meihong, Zhang Kaiwen, Li Ting, Chen Yuye, Zang Hu, Hu Yingjie, Yao Wenlong
Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.
Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China.
J Pain Res. 2023 May 9;16:1533-1546. doi: 10.2147/JPR.S404226. eCollection 2023.
Peripheral nerve block is often used to relieve postoperative pain. But the effect of nerve block on inflammatory response is not fully understood. Spinal cord is the primary center of pain processing. This study is to investigate the effect of single sciatic nerve block on the inflammatory response of the spinal cord in rats with plantar incision and the combined effect with flurbiprofen.
The plantar incision was used to establish a postoperative pain model. Single sciatic nerve block, intravenous flurbiprofen or the combination of both were used for intervention. The sensory and motor functions after nerve block and incision were evaluated. The changes of IL-1β, IL-6, TNF-α, microglia and astrocytes in the spinal cord were examined by qPCR and immunofluorescence respectively.
Sciatic nerve block with 0.5% ropivacaine in rats induced sensory block for 2h and motor block for 1.5h. In the rats with plantar incision, the single sciatic nerve block did not alleviate postoperative pain or inhibit the activation of spinal microglia and astrocytes, but the levels of IL-1β and IL-6 in spinal cord were decreased when the nerve block wore off. The combined effect of a single sciatic nerve block and intravenous flurbiprofen not only decreased the levels of IL-1β, IL-6, and TNF-α, but also relieved the pain and alleviated the activation of microglia and astrocytes.
The single sciatic nerve block cannot improve postoperative pain or inhibit the activation of spinal cord glial cells, but can reduce the expression of spinal inflammatory factors. Nerve block combined with flurbiprofen can inhibit spinal cord inflammation and improve postoperative pain. This study provides a reference for rational clinical application of nerve block.
周围神经阻滞常用于缓解术后疼痛。但神经阻滞对炎症反应的影响尚未完全明确。脊髓是疼痛处理的主要中枢。本研究旨在探讨单次坐骨神经阻滞对足底切开大鼠脊髓炎症反应的影响以及与氟比洛芬的联合作用。
采用足底切开建立术后疼痛模型。分别采用单次坐骨神经阻滞、静脉注射氟比洛芬或两者联合进行干预。评估神经阻滞和切开后感觉及运动功能。分别通过qPCR和免疫荧光检测脊髓中白细胞介素-1β（IL-1β）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、小胶质细胞和星形胶质细胞的变化。
0.5%罗哌卡因对大鼠进行坐骨神经阻滞可诱导感觉阻滞2小时，运动阻滞1.5小时。在足底切开的大鼠中，单次坐骨神经阻滞未减轻术后疼痛，也未抑制脊髓小胶质细胞和星形胶质细胞的激活，但在神经阻滞消退时脊髓中IL-1β和IL-6水平降低。单次坐骨神经阻滞与静脉注射氟比洛芬联合应用不仅降低了IL-1β、IL-6和TNF-α水平，还缓解了疼痛并减轻了小胶质细胞和星形胶质细胞的激活。
单次坐骨神经阻滞不能改善术后疼痛或抑制脊髓胶质细胞的激活，但可降低脊髓炎症因子的表达。神经阻滞联合氟比洛芬可抑制脊髓炎症并改善术后疼痛。本研究为神经阻滞的合理临床应用提供了参考。
