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Effect of saline irrigation temperature difference on postoperative acute pain and hypothermia during biportal endoscopic spine surgery

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Abstract

Background

Recently, enhanced recovery after surgery (ERAS) protocols have attracted attention; they emphasize on avoiding intraoperative hypothermia while performing lumbar fusion surgery. However, none of the studies have reported the protocol for determining the temperature of saline irrigation during biportal endoscopic spine surgery (BESS) procedure. This study evaluated the effectiveness of warm saline irrigation during BESS in acute postoperative pain and inflammatory reactions.

Materials and methods

Fifty-five patients who underwent BESS procedure were retrospectively analyzed for the incidence of perioperative hypothermia (< 36oC), postoperative inflammatory factors (white blood cells (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin-6 (IL-6), serum amyloid A (SAA)), and clinical outcomes (back visual analog scale (VAS) score, postoperative shivering). The patients were divided into the warm and cold saline irrigation groups.

Results

Hemoglobin, WBC, ESR, creatine kinase, and creatine kinase-muscle brain levels did not significantly differ between the warm and cold saline groups. The mean CRP, IL-6, and SAA levels were significantly higher in the cold saline group than in the warm saline group (p = 0.0058, 0.0028, and 0.0246, respectively); back VAS scores were also higher with a statistically significant difference until two days postoperatively (p < 0.001). During the entire procedure, the body temperature was significantly lower in the cold saline irrigation group, but the hypothermia incidence rate significantly differed 30 min after the operation was started.

Conclusions

Using warm saline irrigation during BESS is beneficial for early recovery after surgery, as it is associated with reduced postoperative pain and complication rates.

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References

  1. Kwon JW, Moon SH, Park SY, Park SJ, Park SR, Suk KS, Kim HS, Lee BH, PMCID (2022) Lumbar Spinal Stenosis: Review Update 2022. Asian Spine J. ;16(5):789–798. doi: 10.31616/asj.2022.0366. Epub 2022 Oct 21. PMID: 36266248; : PMC9633250.Choi YS. Pathophysiology of degenerative disc disease. Asian Spine J. 2009;3(1):39–44. doi: 10.4184/asj.2009.3.1.39. Epub 2009 Jun 30. PMID: 20404946; PMCID: PMC2852042

  2. Yavin D, Casha S, Wiebe S, Feasby TE, Clark C, Isaacs A, Holroyd-Leduc J, Hurlbert RJ, Quan H, Nataraj A, Sutherland GR, Jette N (2017) Lumbar Fusion for Degenerative Disease: A Systematic Review and Meta-Analysis. Neurosurgery. ;80(5):701–715. https://doi.org/10.1093/neuros/nyw162. PMID: 28327997

  3. Kwon JW, Moon SH, Park SY, Park SJ, Park SR, Suk KS, Kim HS, Lee BH (2022) Asian Spine J 16(5):789–798. https://doi.org/10.31616/asj.2022.0366Epub 2022 Oct 21. PMID: 36266248; PMCID: PMC9633250 Lumbar Spinal Stenosis: Review Update 2022

  4. Kim JE, Choi DJ, Park EJJ, Lee HJ, Hwang JH, Kim MC, Oh JS (2019) Biportal Endoscopic spinal surgery for lumbar spinal stenosis. Asian Spine J 13(2):334–342. https://doi.org/10.31616/asj.2018.0210Epub 2019 Apr 30. PMID: 30959588; PMCID: PMC6454273

    Article  PubMed  PubMed Central  Google Scholar 

  5. Zhuang HX, Guo SJ, Meng H, Lin JS, Yang Y, Fei Q (2023) Unilateral biportal endoscopic spine surgery for lumbar spinal stenosis: a systematic review and meta-analysis. Eur Rev Med Pharmacol Sci. ;27(11):4998–5012. https://doi.org/10.26355/eurrev_202306_32617. PMID: 37318474

  6. Debono B, Wainwright TW, Wang MY, Sigmundsson FG, Yang MMH, Smid-Nanninga H, Bonnal A, Le Huec JC, Fawcett WJ, Ljungqvist O, Lonjon G, de Boer HD (2021) Consensus statement for perioperative care in lumbar spinal fusion: enhanced recovery after surgery (ERAS®) Society recommendations. Spine J 21(5):729–752 Epub 2021 Jan 12. PMID: 33444664

    Article  PubMed  Google Scholar 

  7. Pan X, Ye L, Liu Z, Wen H, Hu Y, Xu X (2015) Effect of irrigation fluid temperature on core body temperature and inflammatory response during arthroscopic shoulder surgery. Arch Orthop Trauma Surg 135(8):1131–1139. https://doi.org/10.1007/s00402-015-2246-2Epub 2015 May 17. PMID: 25983115

    Article  PubMed  Google Scholar 

  8. Canturk M, Hakki M, Kocaoglu N (2020) Effects of Isothermic Irrigation on Core Body Temperature During Endoscopic Urethral Stone Treatment Surgery Under Spinal Anesthesia: A Randomized Controlled Trial. Urol J. ;17(1):1–7. https://doi.org/10.22037/uj.v0i0.4524. PMID: 30882163

  9. Yamada T (1999) Serum amyloid A (SAA): a concise review of biology, assay methods and clinical usefulness. Clin Chem Lab Med. ;37(4):381-8. https://doi.org/10.1515/CCLM.1999.063. PMID: 10369107

  10. Steelman VM, Chae S, Duff J, Anderson MJ, Zaidi A (2018) Warming of Irrigation Fluids for Prevention of Perioperative Hypothermia during Arthroscopy: a systematic review and Meta-analysis. Arthroscopy 34(3):930–942e2. https://doi.org/10.1016/j.arthro.2017.09.024Epub 2017 Dec 6. PMID: 29217304

    Article  PubMed  Google Scholar 

  11. Oh JH, Kim JY, Chung SW, Park JS, Kim DH, Kim SH, Yun MJ (2014) Warmed irrigation fluid does not decrease perioperative hypothermia during arthroscopic shoulder surgery. Arthroscopy. ;30(2):159 – 64. doi: 10.1016/j.arthro.2013.11.017. PMID: 24485109

  12. Sun M, Chu F, Zhang L, Zhao R, Liu X, Yu H, Pan B, Wu J, Yuan F (2022) Effect of medium with moderate temperature on patient’s body temperature during percutaneous endoscopic lumbar discectomy. J Orthop Surg Res 17(1):336. https://doi.org/10.1186/s13018-022-03226-xPMID: 35765022; PMCID: PMC9237985

    Article  PubMed  PubMed Central  Google Scholar 

  13. de Gonzalo-Calvo D, Neitzert K, Fernández M, Vega-Naredo I, Caballero B, García-Macía M, Suárez FM, Rodríguez-Colunga MJ, Solano JJ, Coto-Montes A (2010) Differential inflammatory responses in aging and disease: TNF-alpha and IL-6 as possible biomarkers. Free Radic Biol Med 49(5):733–737 Epub 2010 Jun 1. PMID: 20639132

    Article  PubMed  Google Scholar 

  14. Farrell SF, de Zoete RMJ, Cabot PJ, Sterling M (2020) Systemic inflammatory markers in neck pain: a systematic review with meta-analysis. Eur J Pain 24(9):1666–1686. https://doi.org/10.1002/ejp.1630Epub 2020 Jul 20. PMID: 32621397

    Article  PubMed  Google Scholar 

  15. DeVon HA, Piano MR, Rosenfeld AG, Hoppensteadt DA The association of pain with protein inflammatory biomarkers: a review of the literature. Nurs Res. 2014 Jan-Feb;63(1):51–62. https://doi.org/10.1097/NNR.0000000000000013. PMID: 24335913

  16. Schmied H, Kurz A, Sessler DI, Kozek S, Reiter A (1996) Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty. Lancet. ;347(8997):289 – 92. https://doi.org/10.1016/s0140-6736(96)90466-3. PMID: 8569362

  17. Doufas AG (2003) Consequences of inadvertent perioperative hypothermia. Best Pract Res Clin Anaesthesiol. ;17(4):535 – 49. https://doi.org/10.1016/s1521-6896(03)00052-1. PMID: 14661656

  18. Salo M (1992) Effects of anaesthesia and surgery on the immune response. Acta Anaesthesiol Scand. ;36(3):201 – 20. https://doi.org/10.1111/j.1399-6576.1992.tb03452.x. PMID: 1574967

  19. Board TN, Srinivasan MS (2008) The effect of irrigation fluid temperature on core body temperature in arthroscopic shoulder surgery. Arch Orthop Trauma Surg. ;128(5):531-3. https://doi.org/10.1007/s00402-007-0368-x. Epub 2007 Jun 12. PMID: 17562057

  20. Kim YS, Lee JY, Yang SC, Song JH, Koh HS, Park WK (2009) Comparative study of the influence of room-temperature and warmed fluid irrigation on body temperature in arthroscopic shoulder surgery. Arthroscopy 25(1):24–29 Epub 2008 Oct 10. PMID: 19111215

    Article  PubMed  Google Scholar 

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Author notes

  1. Sub-Ri Park and Young-Hyun Yoon are co-first authors.

Authors and Affiliations

  1. Department of Orthopedic Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Gyeonggi- do, 16988, Republic of Korea

    Sub-Ri Park, Young-Hyun Yoon, Nam-Hoo Kim & Jin-Oh Park

  2. Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea

    Hak-Sun Kim, Seong-Hwan Moon & Si-Young Park

  3. Department of Orthopedic Surgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, 06273, Republic of Korea

    Ji-Won Kwon, Kyung-Soo Suk & Byung Ho Lee

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  1. Sub-Ri Park
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Park, SR., Yoon, YH., Kim, NH. et al. Effect of saline irrigation temperature difference on postoperative acute pain and hypothermia during biportal endoscopic spine surgery. Eur Spine J (2024). https://doi.org/10.1007/s00586-024-08322-6

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