Liposomal Bupivacaine Versus Continuous Nerve Block: Liposomal Bupivacaine May be Non-inferior and More Cost Effective.

BACKGROUND: Regional anesthesia with adductor canal block has become the standard of care for pain management after total knee arthroplasty (TKA). We hypothesized that liposomal bupivacaine (LB) may be noninferior to continuous nerve block with a pain pump in terms of average pain scores, 30- and 90-day readmissions, and emergency department (ED) visits while reducing cost. METHODS: A retrospective chart review was performed on primary TKA patients from 2015 to 2020 by 23 orthopaedic surgeons at a single institution. The inclusion criteria was treatment with LB or a pain pump, and exclusion criteria was receipt of both anesthetics and revision surgery. A total of 2,378 patients met the inclusion criteria with 1,640 patients treated with LB and 738 treated with the pain pump. Demographic differences were not statistically significant. Primary outcomes were average pain scores, 30- and 90-day readmissions, and ED visits. Secondary outcomes were average milligram morphine equivalents per admission, hospital lengths of stay , and costs. RESULTS: There was no significant difference in pain scores on postoperative days 0, 1, 2, or 3 (P = .77, .86, 0.08, and 0.40, respectively), 30- or 90- day readmissions (P = .527 and P = .374), ED visits (P = .129 and P = .108), milligram morphine equivalents utilizations (P = .194), or average hospital LOS (P = .348). We estimated a potential cost savings of $95 per patient and $155,800 over the course of the study. CONCLUSION: LB was found to be noninferior to a pain pump, and the transition to this medication was associated with cost savings.

The lung permeability index: a feasible measurement of pulmonary capillary permeability.

BACKGROUND: We performed this study to determine the pulmonary capillary permeability (PCP) measuring radiolabeled human serum albumin leakage into the lung. The objective was to use PCP to differentiate between cardiogenic and non-cardiogenic pulmonary edema etiologies. METHODS: We conducted this study in 10 patients admitted to the intensive care unit who had recently developed bilateral pulmonary infiltrates and required hemodynamic monitoring. In these patients we determined the association among the lung permeability index, cardiac output, pulmonary capillary wedge pressure, myocardial performance index, and the protein content of the bronchoalveolar lavage as expressed by bronchoalveolar lavage (BAL) total protein and BAL-to-serum protein ratio. Twenty mCi of technetium-labeled albumin was injected and measure in the heart and the lung at 10 and 180 min post-injection. Lung and heart uptake ratios as well as the lung permeability index were calculated. RESULTS: We found a good correlation between the lung permeability index and both the myocardial performance index (cardiac output/pulmonary capillary wedge pressure) and the total protein content of the bronchoalveolar lavage fluid. CONCLUSION: The lung permeability index is a feasible, noninvasive estimation of the pulmonary capillary permeability.

Localized interleukin-10 gene transfer induces apoptosis of alloreactive T cells via FAS/FASL pathway, improves function, and prolongs survival of cardiac allograft.

We hypothesized that localized IL-10 gene transfer can induce alloreactive T cell apoptosis and tested this hypothesis with liposome-mediated ex vivo intracoronary IL-10 gene transfer using a functional heterotopic allograft heart transplant model in rabbits. Localized IL-10 overexpression prolonged cardiac allograft survival over three folds. In parallel with the time-course of IL-10 overexpression, the percentage of apoptotic CD3+ cells among total CD3+ cells was significantly increased in the gene therapy group (36.5+/-3.9%) compared with that in the control group (6.2+/-2.6%, P<0.01) on postoperative day (POD) 3-6, and it was further increased (45.8+/-5.7%) on POD7-10. Apoptotic CD4+ and CD8+ cells were also significantly increased in the gene group (P<0.01). In contrast, the percentage of apoptotic myocytes significantly decreased from 10.1+/-0.8% in the control group to 3.5+/-0.4% in the gene group on POD7-10 (P<0.01). This reduction was inversely correlated with the increase in the percentages of apoptotic CD4+ and CD8+ cells (P<0.01). The percentage of caspase-3 positive myocytes was significantly reduced, although percentages of caspase-3 positive CD4+ and CD8+ cells were markedly increased in the gene group (P<0.01). Moreover, about 60-80% of apoptotic T lymphocytes expressed Fas in the gene group compared with less than 10% in the control group (P<0.01). These results suggest that localized IL-10 gene transfer induces alloreactive T cell apoptosis via the Fas/FasL pathway that may contribute to the alleviated acute rejection, improved cardiac function, and prolonged survival in the IL-10 gene-treated cardiac allografts.