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.
Full Text:PDF (Українська)
Johnson RL, Kopp SL, Burkle CM, Duncan CM, Jacob AK, Erwin PJ, Murad MH, Mantilla CB. Neuraxial vs general anaesthesia for total hip and total knee arthroplasty: a systematic review of comparative-effectiveness research. Br J Anaesth 2016; 116 (2): 163-176. PMID: 26787787. DOI: 10.1093/bja/aev455
Kurtz SM, Ong KL, Lau E, Bozic KJ. Impact of the economic downturn on total joint replacement demand in the United States: updated projections to 2021. J Bone Joint Surg 2014; 96 (8): 624-630. PMID: 24740658. doi: 10.2106/JBJS.M.00285.
Kissin I. Preemptive analgesia. Anesthesiology 2000; 93 (4): 1138-1143. PMID: 11020772.
Fakler JK, Grafe A, Dinger J, Josten C, Aust G. Perioperative risk factors in patients with a femoral neck fracture – influence of 25-hydroxyvitamin D and C-reactive protein on postoperative medical complications and 1-year mortality. BMC Musculoskelet Disord 2016; 17 (1): 51. PMID: 26833068. PMCID: PMC4736308. DOI: 10.1186/s12891-016-0906-1
Mjaaland KE, Kivle K, Svenningsen S, Pripp AH, Nordsletten L. Comparison of markers for muscle damage, inflammation, and pain using minimally invasive direct anterior versus direct lateral approach in total hip arthroplasty: A prospective, randomized, controlled trial. J Orthop Res 2015; 33 (9): 1305-1310. PMID: 25877694. DOI: 10.1002/jor.22911
Watt DG, Horgan PG, McMillan DC. Routine clinical markers of the magnitude of the systemic inflammatory response after elective operation: a systematic review. Surgery 2015; 157 (2): 362-380. PMID: 25616950. DOI: 10.1016/j.surg.2014.09.009
Hughes S.F., Hendricks B.D., Edwards D.R., Bastawrous S.S., Middleton J.F. Lower limb orthopaedic surgery results in changes to coagulation and non-specific inflammatory biomarkers, including selective clinical outcome measures. Eur J Med Res 2013; 18: 40. PMID: 24206644. PMCID: PMC3832226. DOI: 10.1186/2047-783X-18-40
Chapman G, Holton J, Chapman A. A threshold for concern? C-reactive protein levels following operatively managed neck of femur fractures can detect infectious complications with a simple formula. Clin Biochem 2016: 49 (3): 219-224. PMID: 26522777. DOI: 10.1016/j.clinbiochem.2015.10.018
Copyright (c) 2017 EMERGENCY MEDICINE
This work is licensed under a Creative Commons Attribution 4.0 International License.
© Publishing House Zaslavsky, 1997-2019