PMID- 23353589
OWN - NLM
STAT- MEDLINE
DCOM- 20130619
LR  - 20220331
IS  - 1643-3750 (Electronic)
IS  - 1234-1010 (Print)
IS  - 1234-1010 (Linking)
VI  - 19
DP  - 2013 Jan 28
TI  - Epidural anesthesia followed by epidural analgesia produces less inflammatory 
      response than spinal anesthesia followed by intravenous morphine analgesia in 
      patients with total knee arthroplasty.
PG  - 73-80
AB  - BACKGROUND: Anesthesia and inflammatory response have been studied in major 
      abdominal and thoracic surgical procedures, but not in major orthopaedic 
      reconstructive procedures such as total knee arthroplasty. Most studies have 
      compared general anesthesia with epidural anesthesia, but none has compared 
      epidural with spinal. MATERIAL/METHODS: In a prospective randomized study, 2 
      groups of patients scheduled for total knee arthroplasty for osteoarthritis were 
      evaluated regarding the inflammatory response to 2 types of regional anesthesia. 
      In 30 patients (Group A) with spinal anesthesia followed by intravenous morphine 
      analgesia, and in 26 patients (Group B) with epidural anesthesia followed by 
      epidural analgesia, the inflammatory response was assessed through the 
      calculation of leucocyte concentration (WBC), C-reactive protein (CRP), monocyte 
      chemotactic protein 1 (MCP-1), interleukins (IL-1, IL-6, IL-10, IL-18), TNF-a, 
      and leucocyte activation molecules CD11b and CD62l, in 3 blood samples 
      (immediately before induction to anesthesia, immediately after closure of the 
      operative wound, and at 24 hours post-operatively). RESULTS: The MCP-1 values 
      showed a statistically significant increase (p<0.02) in the group of patients 
      with spinal anesthesia. Of the leucocyte activation molecules, a high 
      statistically significant increase was noticed in the expression of CD11b on 
      monocytes in the sample taken 24 hours post-operatively in the patients of group 
      A. Similarly, CD62l expression on neutrophils showed a high statistically 
      significant reduction in the sample taken 24 hours post-operatively in the group 
      of patients with spinal anesthesia compared to the group of patients with 
      epidural anesthesia. CONCLUSIONS: Our results show that epidural anesthesia 
      followed by epidural analgesia produced less inflammatory response compared with 
      spinal anesthesia followed by intravenous morphine analgesia in patients operated 
      on with total knee arthroplasty, and that the most sensitive markers of those 
      investigated were the CD11b and CD62l leucocyte activation molecules.
FAU - Chloropoulou, Pelagia
AU  - Chloropoulou P
AD  - Department of Anaesthesiology, Democritus University of Thrace, and Department of 
      Biopathology, University General Hospital of Alexandroupolis, Alexandroupolis, 
      Greece. dveretta@med.duth.gr
FAU - Iatrou, Christos
AU  - Iatrou C
FAU - Vogiatzaki, Theodosia
AU  - Vogiatzaki T
FAU - Kotsianidis, Ioannis
AU  - Kotsianidis I
FAU - Trypsianis, Grigorios
AU  - Trypsianis G
FAU - Tsigalou, Christina
AU  - Tsigalou C
FAU - Paschalidou, Eleftheria
AU  - Paschalidou E
FAU - Kazakos, Konstantinos
AU  - Kazakos K
FAU - Touloupidis, Stavros
AU  - Touloupidis S
FAU - Simopoulos, Konstantinos
AU  - Simopoulos K
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20130128
PL  - United States
TA  - Med Sci Monit
JT  - Medical science monitor : international medical journal of experimental and 
      clinical research
JID - 9609063
RN  - 0 (Biomarkers)
RN  - 0 (Cytokines)
RN  - 76I7G6D29C (Morphine)
RN  - 9007-41-4 (C-Reactive Protein)
SB  - IM
MH  - Aged
MH  - *Analgesia, Epidural
MH  - *Anesthesia, Epidural
MH  - *Anesthesia, Spinal
MH  - *Arthroplasty, Replacement, Knee
MH  - Biomarkers/metabolism
MH  - C-Reactive Protein/metabolism
MH  - Cytokines/blood
MH  - Female
MH  - Humans
MH  - Inflammation/*pathology
MH  - Injections, Intravenous
MH  - Leukocytes/metabolism
MH  - Male
MH  - Middle Aged
MH  - Morphine/administration & dosage/*pharmacology
PMC - PMC3628992
EDAT- 2013/01/29 06:00
MHDA- 2013/06/20 06:00
PMCR- 2013/02/28
CRDT- 2013/01/29 06:00
PHST- 2013/01/29 06:00 [entrez]
PHST- 2013/01/29 06:00 [pubmed]
PHST- 2013/06/20 06:00 [medline]
PHST- 2013/02/28 00:00 [pmc-release]
AID - 883749 [pii]
AID - 10.12659/msm.883749 [doi]
PST - epublish
SO  - Med Sci Monit. 2013 Jan 28;19:73-80. doi: 10.12659/msm.883749.