Pain Management, Functional Recovery, and Stress Response Expressed by NLR and PLR after the iPACK Block Combined with Adductor Canal Block for Total Knee Arthroplasty—A Prospective, Randomised, Double-Blinded Clinical Trial
Introduction: This study aimed to investigate pain management, functional recovery, and stress response expressed by the neutrophile-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) after the popliteal artery and posterior knee capsule infiltration (iPACK) block combined with adducto...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-11-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/22/7088 |
| _version_ | 1797458833536188416 |
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| author | Malgorzata Domagalska Tomasz Reysner Grzegorz Kowalski Przemysław Daroszewski Aleksander Mularski Katarzyna Wieczorowska-Tobis |
| author_facet | Malgorzata Domagalska Tomasz Reysner Grzegorz Kowalski Przemysław Daroszewski Aleksander Mularski Katarzyna Wieczorowska-Tobis |
| author_sort | Malgorzata Domagalska |
| collection | DOAJ |
| description | Introduction: This study aimed to investigate pain management, functional recovery, and stress response expressed by the neutrophile-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) after the popliteal artery and posterior knee capsule infiltration (iPACK) block combined with adductor canal block (ACB) in total knee arthroplasty (TKA). Patients and Methods: This was a prospective, double-blinded, randomised, controlled trial in a tertiary referral hospital. Three hundred and sixty-six patients were randomly allocated into the sham block group and iPACK combined with the ACB group. The primary outcome was postoperative pain scores. The secondary outcomes were opioid consumption, functional recovery expressed by a range of motion, and quadriceps strength. Also, the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were calculated. Results: There were significant differences between the sham block and iPACK + ACB group in pain scores <i>p</i> < 0.0001 at all time points. Therefore, there was a significant difference in opioid consumption (<i>p</i> < 0.0001) and functional recovery (<i>p</i> < 0.0001). Also, NLR and PLR levels 12 h (<i>p</i> < 0.0001) and 24 h (24 h) after surgery (<i>p</i> < 0.0001) were much lower in the iPACK + ACB group. Conclusion: After total knee arthroplasty, the iPACK combined with ACB block group improved pain management, functional recovery, and stress response. Therefore, we strongly recommend this technique as a part of a multimodal analgesia protocol in knee surgery. |
| first_indexed | 2024-03-09T16:42:51Z |
| format | Article |
| id | doaj.art-39fa6cea527e4ad297ac50be13b5c02f |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T16:42:51Z |
| publishDate | 2023-11-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-39fa6cea527e4ad297ac50be13b5c02f2023-11-24T14:49:25ZengMDPI AGJournal of Clinical Medicine2077-03832023-11-011222708810.3390/jcm12227088Pain Management, Functional Recovery, and Stress Response Expressed by NLR and PLR after the iPACK Block Combined with Adductor Canal Block for Total Knee Arthroplasty—A Prospective, Randomised, Double-Blinded Clinical TrialMalgorzata Domagalska0Tomasz Reysner1Grzegorz Kowalski2Przemysław Daroszewski3Aleksander Mularski4Katarzyna Wieczorowska-Tobis5Department of Palliative Medicine, University of Medical Sciences, 61-701 Poznań, PolandDepartment of Palliative Medicine, University of Medical Sciences, 61-701 Poznań, PolandDepartment of Palliative Medicine, University of Medical Sciences, 61-701 Poznań, PolandDepartment of Spine Disorders and Pediatric Orthopedics, Poznan University of Medical Sciences, 61-545 Poznań, PolandDepartment of Forensic Medicine, Institute of Medical Sciences Collegium Medicum, University of Zielona Góra, 65-046 Zielona Góra, PolandDepartment of Palliative Medicine, University of Medical Sciences, 61-701 Poznań, PolandIntroduction: This study aimed to investigate pain management, functional recovery, and stress response expressed by the neutrophile-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) after the popliteal artery and posterior knee capsule infiltration (iPACK) block combined with adductor canal block (ACB) in total knee arthroplasty (TKA). Patients and Methods: This was a prospective, double-blinded, randomised, controlled trial in a tertiary referral hospital. Three hundred and sixty-six patients were randomly allocated into the sham block group and iPACK combined with the ACB group. The primary outcome was postoperative pain scores. The secondary outcomes were opioid consumption, functional recovery expressed by a range of motion, and quadriceps strength. Also, the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were calculated. Results: There were significant differences between the sham block and iPACK + ACB group in pain scores <i>p</i> < 0.0001 at all time points. Therefore, there was a significant difference in opioid consumption (<i>p</i> < 0.0001) and functional recovery (<i>p</i> < 0.0001). Also, NLR and PLR levels 12 h (<i>p</i> < 0.0001) and 24 h (24 h) after surgery (<i>p</i> < 0.0001) were much lower in the iPACK + ACB group. Conclusion: After total knee arthroplasty, the iPACK combined with ACB block group improved pain management, functional recovery, and stress response. Therefore, we strongly recommend this technique as a part of a multimodal analgesia protocol in knee surgery.https://www.mdpi.com/2077-0383/12/22/7088pain managementneutrophil-to-lymphocyte ratioplatelet-to-lymphocyte ratiostress responseperipheral nerve blockregional anaesthesia |
| spellingShingle | Malgorzata Domagalska Tomasz Reysner Grzegorz Kowalski Przemysław Daroszewski Aleksander Mularski Katarzyna Wieczorowska-Tobis Pain Management, Functional Recovery, and Stress Response Expressed by NLR and PLR after the iPACK Block Combined with Adductor Canal Block for Total Knee Arthroplasty—A Prospective, Randomised, Double-Blinded Clinical Trial Journal of Clinical Medicine pain management neutrophil-to-lymphocyte ratio platelet-to-lymphocyte ratio stress response peripheral nerve block regional anaesthesia |
| title | Pain Management, Functional Recovery, and Stress Response Expressed by NLR and PLR after the iPACK Block Combined with Adductor Canal Block for Total Knee Arthroplasty—A Prospective, Randomised, Double-Blinded Clinical Trial |
| title_full | Pain Management, Functional Recovery, and Stress Response Expressed by NLR and PLR after the iPACK Block Combined with Adductor Canal Block for Total Knee Arthroplasty—A Prospective, Randomised, Double-Blinded Clinical Trial |
| title_fullStr | Pain Management, Functional Recovery, and Stress Response Expressed by NLR and PLR after the iPACK Block Combined with Adductor Canal Block for Total Knee Arthroplasty—A Prospective, Randomised, Double-Blinded Clinical Trial |
| title_full_unstemmed | Pain Management, Functional Recovery, and Stress Response Expressed by NLR and PLR after the iPACK Block Combined with Adductor Canal Block for Total Knee Arthroplasty—A Prospective, Randomised, Double-Blinded Clinical Trial |
| title_short | Pain Management, Functional Recovery, and Stress Response Expressed by NLR and PLR after the iPACK Block Combined with Adductor Canal Block for Total Knee Arthroplasty—A Prospective, Randomised, Double-Blinded Clinical Trial |
| title_sort | pain management functional recovery and stress response expressed by nlr and plr after the ipack block combined with adductor canal block for total knee arthroplasty a prospective randomised double blinded clinical trial |
| topic | pain management neutrophil-to-lymphocyte ratio platelet-to-lymphocyte ratio stress response peripheral nerve block regional anaesthesia |
| url | https://www.mdpi.com/2077-0383/12/22/7088 |
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