RESUMO
BACKGROUND: The aim of this study was to compare morning surgery (Group A), characterized by high cortisol levels, with afternoon surgery (Group B), characterized by low cortisol levels, with respect to cortisol, inflammatory cytokines (interleukin [IL]-6, IL-8), and postoperative hospital days (POHD) after hip surgery. METHODS: The study was conducted in a single center, prospective, randomized (1:1) parallel group trial. Patients undergoing total hip replacement or hemiarthroplasty were randomly divided into two groups according to the surgery start time: 8 AM (Group A) or 1-2 PM (Group B). Cortisol and cytokine levels were measured at 7:30 AM on the day of surgery, before induction of anesthesia, and at 6, 12, 24, and 48âhours (h) after surgery. Visual analogue scale (VAS) and POHD were used to evaluate the clinical effect of surgery start time. VAS was measured at 6, 12, 24, and 48âh postoperatively, and POHD was measured at discharge. RESULTS: In total, 44 patients completed the trial. The postoperative cortisol level was significantly different between the two groups. (24âh, Pâ<â.001; 48âh, Pâ<â.001). The percentage of patients whose level returned to the initial level was higher in Group B than in Group A (Pâ<â.001). Significant differences in IL-6 levels were observed between the two groups at 12, 24, and 48âh after surgery (Pâ=â.015; Pâ=â.005; Pâ=â.002), and in IL-8 levels at 12 and 24âh after surgery (Pâ=â.002, Pâ<â.001). There was no significant difference between the two groups in VAS and POHD. However, only three patients in Group A were inpatients for more than 3 weeks (Pâ=â.233). CONCLUSIONS: Afternoon surgery allowed for more rapid recovery of cortisol to the baseline level than morning surgery, and IL-6 and IL-8 were lower at 1-2 days postoperatively. The results of this study suggest that afternoon surgery may be considered in patients with postoperative delayed wound healing or inflammation because of the difference in cortisol, IL-6 and 8 in according to surgery start time. CLINICAL TRIAL REGISTRATION NUMBER: NCT03076827 (ClinicalTRrial.gov).
Assuntos
Artroplastia de Quadril/métodos , Hidrocortisona/sangue , Interleucina-6/sangue , Interleucina-8/sangue , Idoso , Idoso de 80 Anos ou mais , Ritmo Circadiano , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Período Pré-Operatório , Estudos Prospectivos , Fatores de Tempo , Escala Visual Analógica , CicatrizaçãoRESUMO
BACKGROUPD: This study investigated the plasma fentanyl concentration and efficacy of transdermal fentanyl patch (TFP) (25âµg/h) in the management of acute postoperative pain. METHODS: Patients undergoing laparoscopic cholecystectomy were randomly allocated to 2 groups. The TFP group (nâ=â30) received a single TFP 25âµg/ h to the anterior chest wall 14âh before operation. The IV group (nâ=â30) received a placebo patch. After the operation, intravenous fentanyl infusion (25âµg/h) was begun with loading dose 25 µg in the IV group and only normal saline in the TFP group. Plasma fentanyl levels were measured at admission, 1, 6, 12, 24, and 48âh postoperatively. Pain severity and adverse effects were evaluated too. RESULTS: The fentanyl level peaked 1âh after operation in the TFP group (3.27â±â0.34âng/mL) and 24âh postoperatively in the IV group (2.9â±â0.42âng/mL). Pain scores and the use of rescue analgesics were not significantly different between 2 groups. Respiratory depression was not happened in both groups. CONCLUSIONS: The TFP (25âµg/h) affixed 14âh before surgery reached a higher constant concentration than the same dose setting of a constant IV infusion of fentanyl after surgery. Although the concentration of fentanyl was higher than those of previous researches, there was no respiratory depression. But, there was no advantage of reducing pain score and the use of rescue analgesics. CLINICAL TRIAL REGISTRATION: (available at: http://cris.nih.go.kr, KCT0002221).