Effect of interscalene nerve block on the inflammatory response in shoulder surgery: a randomized trial

Published on Jun 18, 2019in Journal of Shoulder and Elbow Surgery2.817
· DOI :10.1016/J.JSE.2019.02.030
Gabriel Enrique Mejía-Terrazas3
Estimated H-index: 3
,
Michell Ruiz-Suarez6
Estimated H-index: 6
+ 2 AuthorsEunice López-Muñoz5
Estimated H-index: 5
(Mexican Social Security Institute)
Sources
Abstract
Background Comparing techniques of general anesthesia and regional anesthesia in arthroscopic shoulder surgery, some studies have shown differences in the intensity of immediate postoperative pain and neuroendocrine response, but the inflammatory response when using balanced general anesthesia (BGA) vs. an ultrasound-guided (USG) single-dose interscalene block (SDIB) has not been compared. Materials and methods In a single-center, prospective, randomized clinical trial, the inflammatory response of 2 groups of 10 patients scheduled to undergo arthroscopic shoulder surgery was evaluated through measurement of a panel of cytokines that act on cells of the adaptive immune response to promote or inhibit inflammation, chemokines involved in chemotaxis, the erythrocyte sedimentation rate (ESR), the high-sensitivity C-reactive protein (CRP) level, and the white blood cell (WBC) count in 3 blood samples (before anesthesia, immediately postoperatively, and 24 hours postoperatively) with 2 types of anesthesia (BGA vs. USG SDIB). Postoperative pain intensity (immediately, at 12 hours, and at 24 hours) was also assessed. Results The ESR and CRP level increased significantly at 24 hours after surgery; however, the increase in ESR ( P P P = .022) and interleukin 12p40 ( P = .016) occurred in the immediate postoperative period in the USG SDIB group. Immediate postoperative pain showed a significant increase ( P Conclusions In arthroscopic shoulder surgery, the use of a USG SDIB compared with the use of BGA is possibly associated with improved pain control in the immediate postoperative period and lower immunosuppression, even at 24 hours after surgery.
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