Anesthesia via peripheral nerve blocks during total knee replacement has no effect on postoperative inflammation in elderly patients

Abstract

Background We have previously shown that, compared with general anesthesia (GA), the procedure of peripheral nerve blocks (PNB) facilitates faster recovery of elderly patients from total knee replacement (TKR). Here, we investigated whether the faster recovery is associated with decreased perioperative stress and inflammation and decreased incidences of postoperative complications. Methods After randomization, 165 patients aged ≥65 years underwent TKR under GA or PNB. The primary outcomes were the perioperative inflammation and stress levels, based on the serum C-reactive protein and interleukin-6 levels, erythrocyte sedimentation rate, white-blood cell and neutrophil counts, and blood-sugar level. The secondary outcomes were the postoperative complications, including cardiovascular, respiratory, and hepatic or renal complications, insomnia, delirium, electrolyte disturbances, and nausea and vomiting. Results The two groups were not significantly demographically different ( p > .05). Of the cytokines related to stress and inflammation, the differences of time points were statistically significant between the two groups ( p < .01), but two-way ANOVA revealed no interaction between the time points and groups. Incidences of postoperative complications were far lower in PNB group than in GA group ( p = .006). Incidences of postoperative respiratory complications ( p = .005) and postoperative nausea and vomiting ( p = .040) were significantly lower in PNB group than in GA group. There were no significant differences in other complications between the two groups ( p > .05). Conclusions PNB does not alleviate the stress and inflammation in elderly patients post TKR but significantly reduces the incidences of postoperative complications, especially respiratory complications, and nausea and vomiting. (ClinicalTrials.gov Identifier: NCT01871012)