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Randomized Controlled Trial
. 2018 Nov-Dec;68(6):558-563.
doi: 10.1016/j.bjan.2018.03.004. Epub 2018 Aug 22.

[Changes in the tumor necrosis factor-α level after an ultrasound-guided femoral nerve block in elderly patients with a hip fracture]

[Article in Portuguese]
Ji Su Jang  1 , Yeon-Hee Lee  2 , Hemant K Kandahar  2 , Suman K Shrestha  2 , Jae Sung Lee  3 , Jin-Koo Lee  4 , Seung Jae Park  2 , Na Rea Lee  1 , Jae Jun Lee  5 , Sang-Soo Lee  6
Affiliations
Randomized Controlled Trial

[Changes in the tumor necrosis factor-α level after an ultrasound-guided femoral nerve block in elderly patients with a hip fracture]

[Article in Portuguese]
Ji Su Jang et al. Braz J Anesthesiol. 2018 Nov-Dec.

Abstract

Background and objectives: An ultrasound guided femoral nerve block is an established analgesic method in patients with a hip fracture. Elevated cytokine levels correlate with poor patient outcomes after surgery. Hence, the aim of the study was to describe the levels of tumor necrosis factor-α after an ultrasound-guided femoral nerve block in elderly patients having a femoral neck fracture.

Methods: A total of 32 patients were allocated into two treatment groups: 16 patients (femoral nerve block group; ultrasound-guided femoral nerve block with up to 20 mL of 0.3 mL.kg−1 of 0.5% bupivacaine and intravenous tramadol) and 16 patients (standard management group; up to 3 mL of 0.9% saline in the femoral sheath and intravenous tramadol). Tumor necrosis factor-α and visual analogue scale scores were evaluated immediately before the femoral nerve block and again at 4, 24, and 48 h after the femoral nerve block. All surgery was performed electively after 48 h of femoral nerve block.

Results: The femoral nerve block group had a significantly lower mean tumor necrosis factor-α level at 24 (4.60 vs. 8.14, p < 0.001) and 48 h (5.05 vs. 8.56, p < 0.001) after the femoral nerve block, compared to the standard management group. The femoral nerve block group showed a significantly lower mean visual analogue scale score at 4 (3.63 vs. 7.06, p < 0.001) and 24 h (4.50 vs. 5.75, p < 0.001) after the femoral nerve block, compared to the standard management group.

Conclusions: Ultrasound-guided femoral nerve block using 0.3 mL.kg−1 of 0.5% bupivacaine up to a maximum of 20 mL resulted in a significant lower tumor necrosis factor-α level.

Keywords: Citocinas; Cytokines; Fator de necrose tumoral alfa; Femoral nerve; Fratura de quadril; Hip fracture; Inflammatory response; Nervo femoral; Resposta inflamatória; Tumor necrosis factor alpha.

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Figures

Figure 1
Figure 1
Flow chart of patient enrollment.
Figure 2
Figure 2
VAS score over time in the FNB and SM groups. Data represent mean ± standard error. FNB, femoral nerve block; VAS, visual analog scale; SM, standard management.
Figure 3
Figure 3
TNF-α levels (pg.mL−1) in the FNB and SM groups. Data represent mean ± standard error. TNF-α, tumor necrosis factor-α; SM, standard management; FNB, femoral nerve block.
See this image and copyright information in PMC

References

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