ABSTRACT
Objective To evaluate the role of Toll-like receptor 4 ( TLR4)/nuclear factor kappa B ( NF-κB) signaling pathway in the development of postoperative chronic pain and the relationship with ex-pression of voltage-gated sodium channel 1. 7 (Nav 1. 7) in the dorsal root ganglion (DRG) of rats. Meth-ods Thirty-six clean-grade healthy male Sprague-Dawley rats, aged 9-11 weeks, weighing 200-250 g, were divided into 3 groups ( n=12 each) using a random number table method: control group ( group C) , normal saline group ( group NS) and TLR4 antagonist LPS-RS group ( group R) . Postoperative chronic pain was produced by skin/muscle incision and retraction (SMIR). From 1 day before SMIR to 10 days after SMIR, NS group received continuous intrathecal injection of normal saline 10μl, while R group received continuous intrathecal injection of LPS-RS 20μg/10μl. Six rats were randomly selected in each group, and the mechanical pain threshold was measured at 1 day before SMIR and 1, 5, 10, 15 and 20 days after SMIR. The 6 rats left in each group were sacrificed at day 10 after SMIR, and the DRGs of the lumbar seg-ment (L4,5) were removed for determination of the expression of phosphorylated NF-κB (p-NF-κB) and Nav 1. 7. Results Compared with group C, the mechanical pain threshold was significantly decreased at 5-20 days after SMIR, and the expression of p-NF-κB and Nav1. 7 was up-regulated at 10 days after SMIR in group NS ( P＜0. 01) . Compared with group NA, the mechanical pain threshold was significantly increased at 5-20 days after SMIR, and the expression of p-NF-κB and Nav 1. 7 was down-regulated at 10 days after SMIR in group R (P＜0. 01). Conclusion Up-regulated expression of Nav1. 7 in DRGs after activating TLR4/NF-κB signaling pathway is involved in the development of postoperative chronic pain in rats.
ABSTRACT
Objective To evaluate effects of dexmedetomidine on onset ,duration of supraclavicular brachial plexus block induced by levobupivacaine and postoperative analgesia with ultrasound guide .Methods Eighty patients undergoing elective surgeries of distal arm and forearm with class Ⅰ ~ Ⅱ ASA were enrolled ,and the patients were randomly divided into two groups ,one was control group (group C) patients with supraclavicular brachial plexus block by 30 ml of 5% levobupivacaine contained 1 ml normal saline ,the other was dexmedetomidine group patients (group D) with supraclavicular brachial plexus block by 30 ml of 5% levobupivacaine contained 100μg dexmedetomidine .The supraclavicular brachial plexus block was guided with ultrasound .Observation indicators include :sensory and motor onset blocks ,duration of sensory and motor blocks ,time to first rescue analgesia and hemodynamic parameters .Results The differences of sensory block onset between group C and D were not significant .Compared to group C ,motor block onset of group D was significantly shorter (P<0 .01) ,sensory block duration and motor block duration were longer (P<0.001) ,time to first rescue analgesia after the surgeries was longer (P<0 .001) .Mean arterial pressure and mean heart rate of group D were significantly lower than those of group C ,respectively (P<0 .02) .Conclusions Dexmedetomidine can significantly prolong the duration of block and postoperative analgesia of supracla-vicular brachial plexus block induced by levobupivacaine .
ABSTRACT
Objective To study the effects of parecoxib sodium combined with continuous femoral nerve block on the balance of Th1/Th2 in elderly patients after total knee arthroplasty. Methods Fifty elderly patients,33 males and 1 7 females,aged 65 to 80 years,with ASA Ⅰ or Ⅱtreated with total knee arthroplasty were randomly divided into two groups (n =25 each):parecoxib sodium combined with continuous femoral nerve block group (group A)and parecoxib sodium com-bined with intravenous analgesia group (group B).Quick induce laryngeal mask anesthesia and intra-venous parecoxib sodium 40 mg at 30 min before skin incision were adopted in both groups.After the first 8 h,parecoxib sodium of 40 mg was intravenously injected again.The patients in group A re-ceived femoral nerve puncture and continuous electronic analgesia pump.The patients in group B re-ceived postoperative intravenous electronic analgesia pump.Visual analogue score(VAS)during rest and movement at 6,12,24,36,48 h after operation,side effects in two groups were recorded,venous blood samples were taken before anesthesia (T0 ),at the end of operation (T1 ),and 24 h(T2 ),48 h (T3 ),72 h (T4 )after operation for determination of plasma IFN-γ,IL-10 and cortisol (Cor). Results The values of VAS were significantly lower in group A compared with group B in rest at 6, 12 h after operation,the values of VAS were significantly lower in group A compared with group B in moving at every time points after surgery (P <0.05 ).The plasma Cor concentrations were signifi-cantly increased at T1-T3 compared with baseline value at T0 in two groups(P <0.05 ).The plasma Cor concentrations in group A were significantly decreased compared with group B at T1-T3 (P <0.05).The plasma IFN-γconcentrations were significantly lower at T2 and T3 compared with baseline value at T0 in group A,the plasma IFN-γ concentrations were significantly lower at T2-T4 compared with baseline value at T0 in group B (P <0.05),the plasma IFN-γ concentrations were significantly increased in group A compared with group B at T2-T4 (P <0.05 ).The plasma IL-10 concentrations were significantly increased compared with baseline value at T1-T4 in two groups (P < 0.05 ),the plasma IL-10 concentrations were significantly decreased in group A compared with group B at T1-T4 (P <0.05).Compared with group B,the incidence of postoperative nausea,vomiting and pruritus in group A was lowered significantly (P <0.05).Conclusion Parecoxib sodium combined with continu-ous femoral nerve block on postoperative pain in elderly patients after total knee arthroplasty can a-chieve good effect of postoperative analgesia and fewer complications, lower cortisol secretion, slowing down the decrease of IFN-γ secretion and the increase of IL-10 secretion.This method could effectively protect the immune function of patients undergoing arthroplasty.