Use of low-dose steroids in decreasing cytokine release during bilateral total knee replacement
| Autor: | Michael K. Urban, Kethy M. Jules-Elysee, George Anastasian, Thomas P. Sculco, Neesa Patel, Sarah E. Wilfred, Jane Y. Lipnitsky |
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| Rok vydání: | 2011 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Hydrocortisone Joint replacement medicine.medical_treatment Down-Regulation Blood Pressure Placebo Double-Blind Method Medicine Humans Prospective Studies Range of Motion Articular Prospective cohort study Adverse effect Arthroplasty Replacement Knee Aged Pain Measurement Aged 80 and over Inflammation business.industry Interleukin-6 General Medicine Recovery of Function Middle Aged Placebo Effect Anesthesiology and Pain Medicine Blood pressure Treatment Outcome Anesthesia Orthopedic surgery Female New York City Steroids Hypotension Inflammation Mediators business Range of motion medicine.drug |
| Zdroj: | Regional anesthesia and pain medicine. 36(1) |
| ISSN: | 1532-8651 |
| Popis: | Background: Interleukin 6 (IL-6), a marker of inflammation, is one of the major cytokines released during joint replacement. In the orthopedic patient population, high levels have been linked to many adverse effects including acute respiratory distress syndrome, postoperative mental status changes, and fever. We looked to assess the efficacy of low-dose steroids on the postinflammatory response as measured by IL-6 in patients undergoing bilateral total knee replacement (BTKR). The role of steroids has never been evaluated before in that setting. Methods: Double-blind, randomized, placebo-controlled study of 30 patients undergoing BTKR. The study was powered in order to detect at least a 25% decrease in IL-6 from control. Hydrocortisone (100 mg) or placebo was given at 2 doses 8 hrs apart to the study and control group respectively. Clinical outcome was assessed as well. Results: Levels of IL-6 were 40% lower in the study group by 10 hrs (P = 0.0037) but were similar to the control group at 24 hrs. Greater hemodynamic stability was noted in the study group with fewer episodes of hypotension postoperatively (P = 0.031). Range of motion gained on discharge was also greatest in the study group (P = 0.049). Absence of infection and normal wound healing were noted in all patients. Conclusions: The use of hydrocortisone significantly decreased the inflammatory response in patients undergoing BTKR as measured by IL-6 production. Further studies looking at clinical implications of such findings in a larger patient population and with a longer course of steroids are warranted. |
| Databáze: | OpenAIRE |
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