DOI: https://doi.org/10.22263/2312-4156.2024.5.42
Е.А. Harmatsko1, V.V. Mogulevich1, A.V. Marochkov1,2, S.A. Rymkevich1, A.A. Babrou1
Effectiveness evaluation of nerve block pain management in patients undergoing orthopedic trauma surgeries
1Mogilev Regional Clinical Hospital, Mogilev, Republic of Belarus
2Vitebsk State Order of Peoples’ Friendship Medical University, Vitebsk, Republic of Belarus
Vestnik VGMU. 2024;23(5):42-47.
Abstract.
Objectives. To determine the level of cortisol, C-reactive protein (CRP) and serum iron as an objective criterion for the effectiveness of intraoperative pain management in orthopedic trauma surgeries.
Material and methods. The prospective non-randomized cohort study was conducted in patients (9 males and 16 females). Lower leg and foot surgeries were carried out. US-guided sciatic and femoral nerve blocks were performed. For local anesthesia, lidocaine, ropivacaine or bupivacaine were used. The patients were conscious and responsive, with no pain syndrome. Cortisol, CRP and serum iron levels were measured at three time points.
Results. Cortisol, CRP and serum iron levels were measured at three study stages: before surgery (Stage 1), 60 minutes after the start of surgery (Stage 2) and 18–24 post-surgery hours (Stage 3). CRP levels at Stages 1, 2 and 3 were 3.6 [1.84;14.5], 4.3 [2.46;15.4] and 24.75 [13.36;66.0] mg/L, respectively. Cortisol levels at Stages 1, 2 and 3 were 11.25 [9.7;14.1], 9.6 [6.5;12.5] and 8.8 [6.6;11.9] μg/dL, respectively. Iron levels at Stages 1, 2 and 3 were 18.23 [15.95;25.57], 18.07 [15.35;22.0] and 5.95 [4.47;12.81] µmol/L, respectively.
Conclusions. Based on the study of changes in cortisol, CRP and serum iron levels in patients during surgery and in the first 18–24 post-surgery hours, effectiveness of pain management is reflected by the change in cortisol levels. One day after surgery, a 6.87-fold increase in CRP and a 3.06-fold decrease in serum iron compared to baseline were observed.
Keywords: peripheral nerve block; lower limb surgeries; cortisol; C-reactive protein; serum iron.
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Submitted 12.06.2024
Accepted 18.10.2024
Information about authors:
Е.А. Harmatsko – anesthesiologist-resuscitator of the anesthesiology and resuscitation department, Mogilev Regional Clinical Hospital;
V.V. Mogulevich – anesthesiologist-resuscitator of the anesthesiology and resuscitation department, Mogilev Regional Clinical Hospital,
e-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – V.V. Mogulevich
A.V. Marochkov – Doctor of Medical Sciences, professor, anesthesiologist-resuscitator of the anesthesiology and resuscitation department, Mogilev Regional Clinical Hospital; professor of the branch of the Chairs of Anesthesiology & Resuscitation and Hospital Surgery with the course of the Faculty for Advanced Training and Retraining, Vitebsk State Order of Peoples’ Friendship Medical University, https://orcid.org/0000-0001-5092-8315
S.A. Rymkevich – Head of the anesthesiology and resuscitation department, Mogilev Regional Clinical Hospital;
A.A. Babrou – head of the traumatology and orthopedics department, Mogilev Regional Clinical Hospital.
