MUSCULOSKELETAL SURGERY

, Volume 95, Issue 1, pp 19–24 | Cite as

Postoperative pain monitor after total knee replacement

  • Angela Notarnicola
  • Lorenzo Moretti
  • Silvio Tafuri
  • Angelo Vacca
  • Gioacchino Marella
  • Biagio Moretti
Original Article

Abstract

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.

Keywords

Total knee replacement Postoperative pain Analgesia regimen Cytokines 

References

  1. 1.
    Le Bars D, Adam F (2002) Nociceptors and mediators in acute inflammatory pain. Ann Fr Anesth Reanim 21:315–335PubMedGoogle Scholar
  2. 2.
    Sheeran P, Hall GM (1997) Cytokines in anaesthesia. Br J Anaesth 78:201–219PubMedGoogle Scholar
  3. 3.
    Watkins LR, Maier SF, Goehler LE (1995) Immune activation: the role of pro-inflammatory cytokines in inflammation, illness responses and pathological pain states. Pain 63:289–302PubMedCrossRefGoogle Scholar
  4. 4.
    Samad TA, Moore KA, Sapirstein A, Billet S, Allchorne A, Poole S, Bonventre JV, Woolf CJ (2001) Interleukin-1-mediated induction of COX-2 in the CNS contributes to inflammatory pain hypersensitivity. Nature 410:471–475PubMedCrossRefGoogle Scholar
  5. 5.
    Woolf CJ (2000) Salter MW (2000) Neuronal plasticity: increasing the gain in pain. Science 288:1765–1769PubMedCrossRefGoogle Scholar
  6. 6.
    Bartfai T (2001) Immunology: telling the brain about pain. Nature 410:425PubMedCrossRefGoogle Scholar
  7. 7.
    Karppinen J, Daavittila I, Noponen N, Haapea M, Taimela S, Vanharanta H, Ala-Kokko L, Männikkö M (2008) Is the interleukin-6 haplotype a prognostic factor for sciatica? Eur J Pain 12(8):1018–1025PubMedCrossRefGoogle Scholar
  8. 8.
    Kawasaki Y, Zhang L, Cheng JK, Ji RR (2008) Cytokine mechanisms of central sensitization: distinct and overlapping role of interleukin-1beta, interleukin-6, and tumor necrosis factor-alpha in regulating synaptic and neuronal activity in the superficial spinal cord. J Neurosci 14 28(20):5189–5194CrossRefGoogle Scholar
  9. 9.
    Noponen-Hietala N, Virtanen I, Karttunen R, Schwenke S, Jakkula E, Li H, Merikivi R, Barral S, Ott J, Karppinen J, Ala-Kokko L (2005) Genetic variations in IL6 associated with intervertebral disc disease characterized by sciatica. Pain 114(1–2):186–194PubMedCrossRefGoogle Scholar
  10. 10.
    Wesseldijk F, Huygen FJ, Heijmans-Antonissen C, Niehof SP, Zijlstra FJ (2008) Six years follow-up of the levels of TNF-alpha and IL-6 in patients with complex regional pain syndrome type 1. Mediators Inflamm 469439Google Scholar
  11. 11.
    Barton NJ, Stevens DA, Hughes JP, Rossi AG, Chessell IP, Reeve AJ, McQueen DS (2007) Demonstration of a novel technique to quantitatively assess inflammatory mediators and cells in rat knee joints. J Inflamm (Lond). 13:4–13Google Scholar
  12. 12.
    Duellman TJ, Gaffigan C, Milbrandt JC, Allan DG (2009) Multi-modal, pre-emptive analgesia decreases the length of hospital stay following total joint arthroplasty. Orthopedics 32(3):167PubMedCrossRefGoogle Scholar
  13. 13.
    Eagle KA, Brundage BH, Chaitman BR, Ewy GA, Fleisher LA, Hertzer NR, Leppo JA, Ryan T, Schlant RC, Spencer WH 3rd, Spittell JA Jr, Twiss RD, Ritchie JL, Cheitlin MD, Gardner TJ, Garson A Jr, Lewis RP, Gibbons RJ, O’Rourke RA, Ryan TJ (1995) Guidelines for perioperative cardiovascular evaluation for noncardiac surgery. Report of the American college of cardiology/American heart association task force on practice guidelines (committee on perioperative cardiovascular evaluation for noncardiac surgery). J Am Coll Cardiol 27:910–948Google Scholar
  14. 14.
    Capdevila X, Barthelet Y, Biboulet P, Ryckwaert Y, Rubenovitch J, d’Athis F (1999) Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after minor knee surgery. Anesthesiology 91:8–15PubMedCrossRefGoogle Scholar
  15. 15.
    Chelly JE, Greger J, Gebhard R, Coupe K, Clyburn TA, Buckle R, Criswell A (2001) Continuous femoral blocks improve recovery and outcome of patients undergoing total knee arthroplasty. J Arthroplasty 16:436–445PubMedCrossRefGoogle Scholar
  16. 16.
    Marsili I, Paladini A, Varrassi G (2004) Benefici presunti e dimostrati dell’analgesia peridurale. Minerva anestesiol 5:299Google Scholar
  17. 17.
    Martin F, Martinez V, Mazoit JX, Bouhassira D, Cherif K, Gentili ME, Piriou P, Chauvin M, Fletcher D (2008) Antiinflammatory effect of peripheral nerve blocks after knee surgery: clinical and biologic evaluation. Anesthesiology 109(3):484–490PubMedCrossRefGoogle Scholar
  18. 18.
    Hayami T (2008) Osteoarthritis of the knee joint as a cause of musculoskeletal ambulation disability symptom complex (MADS). Clin Calcium 18(11):1574–1580PubMedGoogle Scholar
  19. 19.
    Dermitzaki E, Staikou C, Petropoulos G, Rizos D, Siafaka I, Fassoulaki A (2009) A randomized study of maternal serum cytokine levels following cesarean section under general or neuraxial anesthesia. Int J Obstet Anesth 18(1):33–37PubMedCrossRefGoogle Scholar
  20. 20.
    Kissin I, Bright CA, Bradley EL Jr (2002) Selective and long-lasting neural blockade with resiniferatoxin prevents inflammatory pain hypersensitivity. Anesth Analg 94(5):1253–1258PubMedCrossRefGoogle Scholar
  21. 21.
    Bagry H, a Fontaine JC, Asenjo JF, Bracco D, Carli F (2008) Effect of a continuous peripheral nerve block on the inflammatory response in knee arthroplasty. Reg Anesth Pain Med 33(1):17–23PubMedGoogle Scholar
  22. 22.
    Beloeil H, Ababneh Z, Chung R, Zurakowski D, Mulkern RV, Berde CB (2006) Effects of bupivacaine and tetrodotoxin on carrageenan-induced hind paw inflammation in rats (part 1): hyperalgesia, edema, and systemic cytokines. Anesthesiology 105:128–138PubMedCrossRefGoogle Scholar
  23. 23.
    Gentili ME, Mazoit JX, Samii KK, Fletcher D (1999) The effect of a sciatic nerve block on the development of inflammation in carrageenan injected rats. Anesth Analg 89:979–984PubMedCrossRefGoogle Scholar
  24. 24.
    Serpell MG, Millar FA, Thomson MF (1991) Comparison of lumbar plexus block versus conventional opioid analgesia after total knee replacement. Anaesthesia 46:275–277PubMedCrossRefGoogle Scholar
  25. 25.
    Weber A, Fournier R, Van Gessel E, Gamulin Z (2002) Sciatic nerve block and the improvement of femoral nerve block analgesia after total knee replacement. Eur J Anaesthesiol 19:834–836PubMedGoogle Scholar
  26. 26.
    Gordon SM, Dionne RA, Brahim J, Jabir F, Dubner R (1997) Blockade of peripheral neuronal barrage reduces postoperative pain. Pain 70:209–215PubMedCrossRefGoogle Scholar
  27. 27.
    Kissin I, Lee SS, Bradley EL Jr (1998) Effect of prolonged nerve block on inflammatory hyperalgesia in rats: prevention of late hyperalgesia. Anesthesiology 88:224–232PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Angela Notarnicola
    • 1
  • Lorenzo Moretti
    • 1
  • Silvio Tafuri
    • 2
  • Angelo Vacca
    • 2
  • Gioacchino Marella
    • 3
  • Biagio Moretti
    • 1
    • 4
  1. 1.Department of Clinical Methodology and Surgical Techniques, Orthopedics Section, Faculty of Medicine and SurgeryUniversity of BariBariItaly
  2. 2.Hygiene Section, Department of Biomedical Sciences and Human Oncology, Faculty of Medicine and SurgeryUniversity of BariBariItaly
  3. 3.Department of AnesthesiologyGeneral HospitalBariItaly
  4. 4.President of Course of Motor and Sports Sciences, Faculty of Medicine and SurgeryUniversity of BariBariItaly

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