Acute phase response in patients undergoing lumbar spinal surgery: modulation by perioperative treatment with naproxen and famotidine

Abstract

In orthopaedic surgery, perioperative administration of non-steroidal anti-inflammatory drugs has been shown to reduce postoperative pain and analgesic consumption. In addition, preoperative administration of ibuprofen has proved to reduce interleukin-6 (IL-6) release, while that of ranitidine reduced postoperative IL-6-induced C-reactive protein synthesis in patients undergoing abdominal surgery. However, it has not been established whether the preoperative administration of both types of drugs may reduced the postoperative inflammatory reaction after instrumented spinal surgery. Accordingly, our objective was to investigate the effects of preoperative treatment with naproxen plus famotidine on the postoperative systemic inflammatory reaction in patients undergoing instrumented lumbar spinal surgery. Forty consecutive patients scheduled for elective instrumented spinal fusion were alternately assigned to receive either naproxen (500 mg/day, p.o.) plus famotidine (40 mg/day, p.o.) for 7 days before operation, or no adjuvant treatment. Haematological parameters, acute phase proteins, complement fractions, immunoglobulins and cytokines were determined 7 days and immediately before surgery, and on days 0, 1, 2 and 7 after surgery. Haematological parameters, clinical data, duration of surgery, blood loss, perioperative blood transfusion and postoperative complications were similar in the two groups, although pretreated patients showed lower increases in body temperature and required less analgesic medication. Compared with preoperative levels, IL-6 levels were significantly increased postoperatively in all patients with no differences between groups. C-reactive protein, alpha(1)-acid-glycoprotein and haptoglobin levels were also significantly increased postoperatively in all patients; however, they were significantly lower in pretreated patients. In conclusion, perioperative treatment with naproxen plus famotidine was well tolerated and reduced the acute phase response after instrumented spinal surgery. However, further research is needed to determine the best dose and timing of preoperative treatment administration, and to correlate these changes with long-term clinical results.

Fig. 1

Perioperative evolution of body temperature in patients receiving either preoperative adjuvant treatment with naproxen plus famotidine (triangles) or no adjuvant treatment (squares). Data are the mean±SD of measurements in 18 or 19 patients (group A vs group B, P<0.001) (−7, preoperative day 7; 0A, beginning of surgery; 0B, end of surgery; 1, postoperative day 1; 2, postoperative day 2; 7, postoperative day 7)

Fig. 2A, B

Perioperative evolution of serum cytokine and acute phase protein levels in patients receiving either preoperative adjuvant treatment with naproxen plus famotidine (triangles) or no adjuvant treatment (squares). Data are the mean±SD of 18 or 19 determinations and results were corrected for haemodilution using the total protein concentration of the preoperative blood sample as control. Serum concentrations of interleukin 6 (IL-6) were measured by ELISA (A group A vs group B: p=NS) and those of C-reactive protein (CRP) by nephelometry (B group A vs group B: p<0.001). (−7, preoperative day 7; 0A, beginning of surgery; 0B, end of surgery; 1, postoperative day 1; 2, postoperative day 2; 7, postoperative day 7)