Systemic Inflammatory Response after Hip Surgery: Comparison of Spinal Anesthesia and Combined Spinal Anesthesia with Paravertebral Blockade
Background. C-reactive protein (CRP) as a biochemical marker for non-specific inflammation provides an objective measure of invasiveness in total hip arthroplasty. Objective. The aim of our study was to compare CRP levels after hip surgery with either combined spinal and paravertebral blockade or spinal anesthesia alone. The aim of our study was to compare C-reactive protein levels after hip surgery with either combined spinal and paravertebral blockade or spinal anesthesia alone. Materials and methods. The prospective single-center cohort study included 22 patients having elective unilateral hip surgery and randomly divided into two groups. There was no statistically significant difference in anthropometric variables between the groups. In the first (control) group (n = 11: 5 men and 6 women), single-shot spinal anesthesia (L3, plain 0.5% bupivacaine, 12 mg) was used. In the second (study) group (n = 11: 4 men and 7 women), the same spinal anesthesia was used intra-operatively; immediately after surgery the ipsilateral paravertebral space at L3 level was catheterized with Perifix 401 kit (B. Braun, Germany) and 1% lidocaine, 20 mL were administered. The unilateral prolonged paravertebral blockade was maintained with continuously administered 0.25% bupivacaine, 3 mL/hr, during the first post-operative day, then with slow 10-mL bolus each 8 hours during 2–3 days more. CRP levels were measured using a latex-enhanced turbidimetric immunoassay technique (Cobas 6000 Analyser, Roche Diagnoctics) preoperatively and on postoperative days 1, 3, and 7. The results are reported as the median (lower quartile — upper quartile [minimum — maximum]), Mann — Whitney U test was used for intergroup difference evaluation. Results. Preoperative CRP levels were 3.3 mg/L (1.2–6.9 [0.6–68.6]) in the first group and 3.5 mg/L (1.6–10.9 [0.1–58.7]) in the second group (р < 0.05). On the first post-operative day, CRP levels were 89.9 mg/L (44.2–131.1 [13.4–157.0]) in the first group and 30.5 mg/L (26.6–71.9 [21.6–89.6]) in the second group, the intergroup difference was statistically significant (p = 0.039). On the third post-operative day, CRP levels were 108.4 mg/L (80.3–146.5 [63.2–178.6]) in the first group and 74.6 mg/L (63.8–103.0 [20.9–160.5]) in the second group, the intergroup difference was statistically significant (p = 0.048). On the seventh post-operative day, CRP levels were 32.6 mg/L (17.5–63.3 [6.3–84.5]) in the first group and 14.9 mg/L (10.6–19.2 [8.8–25.0]) in the second group, the intergroup difference was statistically significant (p = 0.01). Conclusions. Post-operative analgesia with ipsilateral prolonged paravertebral blockade after intra-operative spinal anesthesia for hip surgery is associated with less C-reactive protein augmentation than with spinal anesthesia alone. The correlation between C-reactive protein response and postoperative pain intensiveness needs additional study.
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