SYSTEMIC INFLAMMATORY RESPONSE IN TOTAL KNEE ARTHROPLASTY IN PATIENTS WITH CONTINUOUS ADDUCTOR CANAL BLOCK AND IPACK VERSUS GENERAL ANESTHESIA

  • Angelica Bratu University of Medicine and Pharmacy “Carol Davila’ Bucharest
  • Adina Comănelea Anesthesiology and Intensive Care Department, Bucharest Emergency University Hospital, Romania
  • Adrian Cursaru Orthopedics and Traumatology Department, Bucharest Emergency University Hospital, Romania & “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
  • Bogdan Crețu Orthopedics and Traumatology Department, Bucharest Emergency University Hospital, Romania & “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
  • Bogdan Șerban Orthopedics and Traumatology Department, Bucharest Emergency University Hospital, Romania & “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
  • Cătălin Cîrstoiu Orthopedics and Traumatology Department, Bucharest Emergency University Hospital, Romania & “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
Keywords: Total knee arthroplasty (TKA), peripheral nerve blocks (PNB), interleukin-6, interleukin-8, MCP-1(Monocyte Chemoattractant Protein-1), CRP (C-Reactive Protein)

Abstract

Abstract

Amplitude of the systemic inflammatory response secondary to the trauma associated with surgical procedure correlates with dynamics of the postoperative evolution so, it becomes necessary to investigate all the resources that can support the limitation of systemic inflammatory response. Our study enrolled 40 patients of the University Hospital Bucharest Orthopedic Clinic, scheduled for Total Knee Arthroplasty, assigned to 2 groups differing in anesthesia and analgesia protocol. First group received spinal anesthesia associated with continuous adductor canal block and iPACK (interpopliteal artery and posterior capsule of the knee blockade), analgesia included continuous adductor canal block in postoperative multimodal analgesia protocol. Second group received general anesthesia, postoperative analgesia with opioid. Main objective was to quantify systemic inflammatory response in the PNB group compared to GA group. This was assessed by measuring markers of inflammation: leukocytes, fibrinogen, PCR, IL-6, IL-8 and MCP-1, preoperatively, at 24 and 48 hours postoperatively. At 24 hours postoperatively, higher values were recorded for CRP and leukocyte in GA group. At 48 hours, plasmatic concentration of CRP, IL-6, MCP-and fibrinogen, recorded higher values in GA group. IL-8 did not have significant pharmacokinetics. New techniques of peripheral locoregional anesthesia represented by ultrasound-guided peripheral nerve blocks appear to be of significant benefit in limiting the magnitude of the systemic inflammatory response associated with surgical trauma.

References

1. William K. Oelsner, BS, Stephen M. Engstrom, MD, Michael A. Benvenuti, BS; Characterizing the acute phase response in healthy patients following total joint arthroplasty: predictable and consistent. The journal of arthroplasty.2016; 1-6
2. Cretu B, Cirstoiu C, Cristea S. Current review of surgical management options for rotational alignment of the femoral and tibial component in total knee replacement. Romanian Journal of Military Medicine. 2019 AUG 122;2:16-20.
3. Barbara Lisowska, Marta Szymanska, Elzbieta Nowacka. Anesthesiology and the cytokine network. Postepy Hig Med Dosw, 2013; 67:761-769
4. Chen XX, Wang T, Li J, Kang H. Relationship between inflammatory response and estimated complication rate after total hip arthroplasty. Chin Med J 2016;129:2546-2551
5. Wasko MK, Bobecka-Wesołowska K, Tomasiuk R, Kowalczewski J. Measurement of the inflammatory response in the early postoperative period after hip and knee arthroplasty. Clin Chem Lab Med 2015;
6. Jager P, Zaric D, Fomsgaard JS, et al. Adductor canal block versus femoral nerve block for analgesia after total knee arthroplasty: a randomized, doble blind study. Reg Anesth Pain Med. 2013;38:526-532
7. Memtsoudis SG, Sun X, Chiu YL, et al. Perioperative comparative effectiveness of anesthetic tehnique in orthopedic patients. Anesthesiology; (2103) :1046-1058
8. Sandra L. Kopp, MD, Jens Borglum, MD, PhD. Anesthesia and analgesia practice pathway options for total knee arthroplasty. Regional Anesthesia and Pain Medicine 2017; 42:683-697
9. Perlas A, Chan VW, Beattie S. Anaesthesia technique and mortality after total hip or knee arthroplasty: a retrospective, propensity score-matched cohort study. Anesthesiology. 2016; 125:724-731
10. Motaghedi R, Bae J, Memtsoudis S, Kim D, Beathe J, Paroli L, et al. Association of obesity with inflammation and pain after total hip arthroplasty. Clin Orthop Relat Res 2014;472:1442-1448
10. 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(2):362-38
11. Si, Hb., Yang, Tm., Zeng, Y. et al. Correlations between inflammatory cytokines, muscle damage markers and acute postoperative pain following primary total knee arthroplasty. BMC Musculoskelet Disord 18, 265 (2017)
12. Memtsoudis SG, Poeran J, Cozowicz C, Zubizarreta N, Ozbek U, Mazumdar M. The impact of peripheral nerve blocks on perioperative outcome in hip and knee arthroplasty-a population-based study. Pain. 2016;157(10):2341-2349
13. Motaghedi R, Bae J, Memtsoudis S, Kim D, Beathe J, Paroli L, et al. Association of obesity with inflammation and pain after total hip arthroplasty. Clin Orthop Relat Res 2014;472:1442-1448
14. Ohzato H, Yoshizaki K, Nishimoto N et al. Interleukin-6 as a new indicator of inflammatory status: detection of serum levels of interleukin-6 and C-reactive protein after surgery. Surgery 1992; 111:201-209
15. Bagry H, de la Cuadra Fontaine JC, Asenjo JF, Bracco D, Carli F. Effect of a continuous peripheral nerve block on the inflammatory response in knee arthroplasty. Reg Anesth Pain Med. 2008;33:17-23
16. Demura S, Takahashi K, Tomita K. Serum interleukin-6 response after spinal surgery: Estimation of surgical magnitude. J Orthop Sci 2006;11:241-247
17. Yombi SC, Schwab PE, Thienpont E. Serum c-reactive protein distribution in minimally invasive total knee arthroplasty do not differ with distribution in conventional total knee arthroplasty. PloS One 2015;10:e0124788
18. Shen H, Zhang N, Zhang X, Ji W. C-reactive protein levels after 4 types of arthroplasty. Acta Orthop 2009; 80:330-333
19. Neumaier M, Metak G, Scherer M. C-reactive protein as a parameter of surgical trauma: CRP response after different types of surgery in 349 hip fractures. Acta Orthop 2006; 77:788-790
20. Bottner F, Wegner A, Winkelmann W, Becker K, Erren M, Gotze C. Interleukin 6, procalcitonin and TNF-alpha:markers of periprosthetic infection following total joint replacement. J Bone Joint Surg Am 2005;87:1921-1927
23. Cursaru A, Cretu B, Serban B, Lupu AG, Iacobescu G, Popa M, Cursaru R, Cirstoiu C. Mechanical Safety Study and Antibiotic-loaded Polymethylmethacrylate Spacers Threshold, Manufactured Intraoperatively, in Orthopaedic Surgery. Materiale Plastice. 2020 DEC 57;4: 317-324
Published
2022-05-02
How to Cite
[1]
A. Bratu, A. Comănelea, A. Cursaru, B. Crețu, B. Șerban, and C. Cîrstoiu, “SYSTEMIC INFLAMMATORY RESPONSE IN TOTAL KNEE ARTHROPLASTY IN PATIENTS WITH CONTINUOUS ADDUCTOR CANAL BLOCK AND IPACK VERSUS GENERAL ANESTHESIA”, JSS, vol. 9, no. 1, May 2022.