Postoperative Regional Analgesia Is Effective in Preserving Perforin-Expressing Lymphocytes in Patients After Total Knee Replacement.

BACKGROUND Pain and surgical stress cause a pro-inflammatory response followed by downregulation of the immune response, which can increase the incidence of postoperative complications, such as infections or prolonged wound healing. T lymphocytes and natural killer (NK) cells have cytotoxic potential and are crucial components of cellular immunity, which is important for maintenance of immune balance. The aim of this study was to analyze the effects of 3 types of postoperative analgesia on the preservation and cytotoxic potential of T lymphocytes, NK cells, and their subpopulations, as well as NKT cells, in patients after total knee replacement (TKR) to find the most effective analgesic technique for mitigating immune suppression. MATERIAL AND METHODS Forty-eight patients scheduled for TKR were randomly allocated to Group 1 (patients received epidural analgesia), Group 2 (patients received sciatic and femoral nerve block), or Group 3 (patients received multimodal systemic analgesia). Pain intensity was assessed at rest and on movement before, immediately after, and at 24 and 72 h after surgery. Blood samples were collected at the same time points and peripheral blood mononuclear cells were isolated. The frequencies of T lymphocytes, NK cells, and NKT cells, as well as their perforin expression, were simultaneously detected and analyzed by flow cytometry. RESULTS Patients in Group 1 and Group 2 experienced less severe pain than those in Group 3. The frequencies and perforin levels of T lymphocytes, their subsets, and NKT cells were significantly lower in Group 3 than in Group 1 and Group 2. CONCLUSIONS The present study confirmed that regional analgesia is more effective in maintaining cell-mediated immunity and perforin expression in peripheral blood lymphocytes in patients after TKR.

Total knee replacement surgery is followed by transitory endothelial dysfunction.

Acute coronary syndrome (ACS) presents today the leading group of post-operative cardiovascular complications, while endothelial dysfunction (ED) is one of the key elements in its development. The chronic ED represents thus the basis for the gradual development of atherosclerotic changes, while its sudden aggravation leads to ACS. The persistent ED occurs due to the effects of chronic cardiovascular risk factors, while according to the available studies it can also develop or aggravate under the impact of different acute events. We have directed this study to the investigation of the dynamic of endothelial function before and after a major orthopaedic surgical intervention. This randomised prospective study included 19 patients that underwent the intervention of total knee replacement and 20 healthy examinees of the adequate age and gender High-resolution ultrasound test based on the flow mediated dilatation of the brachial artery is what at we carried out at the beginning of the research, respectively 12, 24, 48 and 72 hours, as well as 7 days after the surgical intervention. The starting values of the FMD test were within the normal range in both groups, although the ability of dilatation upon stimulus was significantly lower in the investigated group. The FMD percentage change in the total sample was negatively connected with the body weight, not having shown additional connections with other cardiovascular risk factors. During the early post-operative period, a significant transitory lowering of the FMD percentage change was recorded, having reached the lowest value 24 hours after the surgery. During the seven-day prospective surveillance, no significant cardiovascular complications were recorded. Further research is necessary in order to confirm these results as well as the testing of the possible connection of the described post-operative transitory endothelial dysfunction with the development of cardiovascular complications and the adverse event.

Benefit of the minimal invasive ultrasound-guided single shot femoro-popliteal block for ankle surgery in comparison with spinal anesthesia.

BACKGROUND: Ultrasound-guided regional anesthesia has gained popularity for ankle and foot surgery. The aim of our study was to investigate the sufficiency of anesthesia for ankle surgery as well as duration of analgesia in postoperative period, using minimal invasive ultrasound-guided regional anesthesia, and to compare it with anesthesia and postoperative analgesia following spinal anesthesia. METHODS: This prospective study included 40 adult trauma patients with bimalleolar fracture who were scheduled for surgery. They were randomly assigned and divided in two groups. Patients from the first group underwent an Ultrasound-guided femoro-popliteal block (US-FPB), while a spinal anesthesia (SA) was performed for the second group. The local anesthetic 0.5% bupivacaine was used in both groups. RESULTS: Eighteen patients from the first and nineteen patients from the second group completed the study. Levels of anesthesia were sufficient in both groups without significant differences. Duration of postoperative analgesia was significantly higher in US-FPB group in comparison to SA group (12 ± 3 vs. 3 ± 1 h) (p < 0.001). At the same time, onset of complete sensory motor block was significantly faster in SA group in comparison to US-FPB group (5 ± 1 vs. 8 ± 3 min) (p < 0.001). CONCLUSION: Minimal invasive US-FPB provides sufficient anesthesia for ankle fracture. In comparison to the SA group, patients from the US-FPB group achieved significantly longer postoperative analgesia, while faster onset of anesthesia was noted in SA group.