Effect of a Continuous Peripheral Nerve Block on the Inflammatory Response in Knee Arthroplasty

Bagry, Hema; Fontaine, Juan Carlos de la Cuadra; Asenjo, Juan Francisco; Bracco, David; Carli, Franco

doi:10.1016/j.rapm.2007.06.398

Cited by 41 publications

(35 citation statements)

References 22 publications

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“…This stresses the importance of a local blockade of nerve transmission, to prevent the pain that would otherwise lead to local perineural inflammation phenomena, as compared to systemic treatment of inflammation and pain [20]. Thus, local analgesia appears to be better indicated to facilitate subsequent rehabilitation after total knee replacement [14], because by reducing pain, it allows patients to better tolerate early passive mobilization [17,21]. Some experimental works have shown that this form of analgesia, by inducing a blockade of C fibers through a mechanism that has not yet been entirely clarified, can inhibit perineural inflammation [22,23].…”

Section: Discussionmentioning

confidence: 99%

“…Various experiences have demonstrated that isolated blockade of the femoral nerve can achieve a better postoperative analgesia than blockade of the sciatic nerve or combined sciatic and femoral blockade. This suggests that the posterior territory, innervated by the sciatic nerve, may contribute only marginally to the onset of postoperative pain [21].…”

Section: Discussionmentioning

confidence: 99%

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Postoperative pain monitor after total knee replacement

et al. 2011

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Aim of this work was to study the postoperative pain within the first week of a total knee replacement by comparing three different forms of administration of analgesia. We proposed to verify the correspondence between a subjective pain assessment made by the patient on a Visual Analogic Scale (VAS) and an objective assessment made by assaying the serum algogenic cytokines interleukin-1 (IL1), interleukin-6 (IL6), and tumor necrosis factor-alpha (TNF-alpha). Statistical analysis of the data on the VAS and the three cytokine assays done preoperatively and on the third and seventh days postoperatively showed that while the VAS declined progressively postoperatively, IL6 tended to be higher on the third postoperative day and then lower on the seventh. The other two cytokines showed no differences preoperatively and postoperatively. On the basis of our results, we support the validity of IL6 dosage to monitor the postoperative pain during future studies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Postoperative pain monitor after total knee replacement

et al. 2011

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“…These leukocytes gather at the site of inflammation, causing the release of cytokines, resulting in a more robust local immune responss. 36 Surgical trauma has been shown to provoke an inflammatory state that causes the release of inflammatory cytokines. This cytokine release results in inflammation at the sight of injury as well as inflammation that cause systemic effects.…”

Section: Inflammatory Responsementioning

confidence: 99%

“…Similarly, synthesis of acute phase proteins produced in the liver also play a role in the stress response, as well as the modulation and release of inflammatory cytokines. 36 Reducing the inflammatory response can lead to decreased immunosuppression which enhances recovery. 36,44 Release of substance P and neurokinin have been shown in murine models to induce peripheral inflammation.…”

Section: Inflammatory Responsementioning

confidence: 99%

“…36 Reducing the inflammatory response can lead to decreased immunosuppression which enhances recovery. 36,44 Release of substance P and neurokinin have been shown in murine models to induce peripheral inflammation. This increase in peripheral inflammation led to a quick rise in axonal transport of the neurogenic substances (substance P and neurokinin) that peaked on the first day after insult, and subsequently returned to normal one week after insult.…”

Section: Inflammatory Responsementioning

confidence: 99%

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Physiologic Advantages of Peripheral Nerve Blockade Translate to Decreased Length of Stay and Improved Patient Satisfaction

Kerfeld¹,

Hambsch²,

McEntire³

et al. 2016

Anesthesiol Open J

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Review ABSTRACTPeripheral nerve blockade is an effective modality involved in controlling perioperative pain. When compared with patient controlled analgesia, neuraxial analgesia, and other anesthetic methods such as periarticular infiltration, peripheral nerve blocks yield superior pain control and reduce length of hospitalization. Not only do these techniques help with patient satisfaction and health care costs, they also have physiologic advantages. In murine models, peripheral nerve blockade reduces expression of different inflammatory markers such as IL-1, IL-6, TNFα and cortisol. Such advantages make this an attractive modality for pain control.

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Femoral nerve blocks for acute postoperative pain after knee replacement surgery

Chan

Fransen

Parker

et al. 2014

Cochrane Database of Systematic Reviews

164

112

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Background Total knee replacement (TKR) is a common and o en painful operation. Femoral nerve block (FNB) is frequently used for postoperative analgesia. Objectives To evaluate the benefits and risks of FNB used as a postoperative analgesic technique relative to other analgesic techniques among adults undergoing TKR. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) 2013, Issue 1, MEDLINE, EMBASE, CINAHL, Web of Science, dissertation abstracts and reference lists of included studies. The date of the last search was 31 January 2013. Selection criteria We included randomized controlled trials (RCTs) comparing FNB with no FNB (intravenous patient-controlled analgesia (PCA) opioid, epidural analgesia, local infiltration analgesia, and oral analgesia) in adults a er TKR. We also included RCTs that compared continuous versus single-shot FNB. Data collection and analysis Two review authors independently performed study selection and data extraction. We undertook meta-analysis (random-e ects model) and used relative risk ratios (RRs) for dichotomous outcomes and mean di erences (MDs) or standardized mean di erences (SMDs) for continuous outcomes. We interpreted SMDs according to rule of thumb where 0.2 or smaller represents a small e ect, 0.5 a moderate e ect and 0.8 or larger, a large e ect. Main results We included 45 eligible RCTs (2710 participants) from 47 publications; 20 RCTs had more than two allocation groups. A total of 29 RCTs compared FNB (with or without concurrent treatments including PCA opioid) versus PCA opioid, 10 RCTs compared FNB versus epidural, five RCTs compared FNB versus local infiltration analgesia, one RCT compared FNB versus oral analgesia and four RCTs compared continuous versus single-shot FNB. Most included RCTs were rated as low or unclear risk of bias for the aspects rated in the risk of bias Femoral nerve blocks for acute postoperative pain a er knee replacement surgery (Review)

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Effect of a Continuous Peripheral Nerve Block on the Inflammatory Response in Knee Arthroplasty

Abstract: Continuous lumbar plexus and sciatic nerve blocks with ropivacaine contribute to the attenuation of the postoperative inflammatory response.

Cited by 41 publications

References 22 publications

Postoperative pain monitor after total knee replacement

Postoperative pain monitor after total knee replacement

Physiologic Advantages of Peripheral Nerve Blockade Translate to Decreased Length of Stay and Improved Patient Satisfaction

Femoral nerve blocks for acute postoperative pain after knee replacement surgery

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