The relationship between neutrophil to lymphocyte ratio and postoperative pain in total knee and hip arthroplasty

Background and objectives: Neutrophil to lymphocyte ratio is a simple, cost-effective and easily applicable inflammation indicator that is being used frequently in mortality, morbidity and prognosis studies in the recent years. We evaluated the relationship between neutrophil to lymphocyte ratio and postoperative pain in patients undergoing total hip arthroplasty and total knee arthroplasty. Material and methods: We included 101 patients who preferred spinal anesthesia and intravenous patient-controlled analgesia in accordance and divided them into two groups, total hip arthroplasty and total knee arthroplasty. We recorded demographic information, duration of operation, length of hospital stay, analgesics consumption, neutrophil to lymphocyte ratio results and postoperative pain using Visual Analog Scale. Results: The morphine consumption of the patients was as follows in group total hip arthroplasty and total knee arthroplasty: at the 4th hour: 7.38 mg, 7.80 mg; 8th hour: 12.19 mg, 13.29 mg; 12th hour: 16.94 mg, 19.18 mg; 24th hour: 25.97 mg, 27.98 mg; 48th hour: 36.38 mg, 39.59 mg. The Visual Analog Scale scores of the patients was as follows in group total hip arthroplasty and total knee arthroplasty: at the 4th hour: 4.10, 4.51; 8th hour: 3.02, 3.43; 12th hour: 2.29, 2.55; 24th hour: 1.90, 1.87; 48th hour: 1.08, 1.13. In group total hip arthroplasty, we found a statistically significant association between postoperative neutrophil to lymphocyte ratio and the Visual Analog Scale values on the 48th hour in a positive direction (r = 0.311; P = 0.031; P < 0.05). Conclusion: Neutrophil to lymphocyte ratio can be accepted as a relatively objective method for the diagnosis of postoperative pain. Resumo: Justificativa e objetivos: A proporção entre neutrófilo/linfócito é um indicador de inflamação simples, custo-efetivo e de fácil aplicação que vem sendo utilizado com frequência em estudos de mortalidade, morbidade e prognóstico nos últimos anos. Avaliamos a relação entre a proporção neutrófilo/linfócito e a dor pós-operatória em pacientes submetidos à artroplastia total de quadril e artroplastia total de joelho. Material e métodos: No total, 101 pacientes que preferiram a raquianestesia e a analgesia venosa controlada pelo paciente foram incluídos e divididos em dois grupos neste estudo: artroplastia total de quadril e artroplastia total de joelho. Os dados demográficos e os tempos de operação, internação hospitalar e consumo de analgésicos e os resultados da proporção neutrófilo/linfócito e da dor pós-operatória foram registrados usando uma escala visual analógica. Resultados: O consumo de morfina dos pacientes submetidos à artroplastia total de quadril e artroplastia total de joelho nas horas 4, 8, 12, 24 e 45 foi de, respectivamente: 7,38 mg e 7,80 mg; 12,19 mg e 13,29 mg; 16,94 mg e 19,18 mg; 25,97 mg e 27,98 mg; 36,38 mg e 39,59 mg. Os escores obtidos na escala visual analógica dos pacientes submetidos à artroplastia total de quadril e artroplastia total de joelho nas horas 4, 8, 12, 24 e 48 foram, respectivamente, os seguintes: 4,10 e 4,51; 3,02 e 3,43; 2,29 e 2,55; 1,90 e 1,87; 1,08 e 1,13. Na artroplastia total do quadril, uma associação estatisticamente significativa foi encontrada entre a proporção neutrófilo/linfócito no pós-operatório e os valores da escala visual analógica na 48ª hora em uma direção positiva (r = 0,311; p = 0,031; p < 0,05). Conclusão: A proporção neutrófilo/linfócito pode ser aceita como um método relativamente objetivo para o diagnóstico da dor pós-operatória. Keywords: Neutrophil to lymphocyte ratio, Postoperative pain, Lower extremity arthroplasty, Total knee arthroplasty, Total hip arthroplasty, Palavras-chave: Relação neutrófilo/linfócito, Dor pós-operatória, Artroplastia de extremidade inferior, Artroplastia total de joelho, Artroplastia total de quadri

Brachial Plexus Injury Associated With Subclavian Vein Cannulation: A Case Report.

We documented brachial plexus injury by electromyography and magnetic resonance imaging secondary to needle sticks for central line insertion. This type of complication is rare in the literature, as few case reports exist. Brachial plexus injury can happen because of anatomic variations. Nevertheless, multiple attempts or introducer needle rotations should be avoided during subclavian vein catheterization. Pain that emerges in the ipsilateral arm after subclavian catheter placement should be taken into serious consideration. It is important to identify the cause of pain as soon as possible so that the correct treatment can be efficiently provided. Use of an ultrasound-guided catheterization may be a better choice for preventing complications

Postoperative analgesia for arthroscopic rotator cuff surgery: a comparison between subacromial and interscalene levobupivacaine

Objectives: Arthroscopic rotator cuff surgery can result in severe postoperative pain. We compared a continuous subacromial infusion to a continuous interscalene block with levobupivacaine for patients undergoing arthroscopic rotator cuff surgery

Two-year experience with cell salvage in total hip arthroplasty

ABSTRACT BACKGROUND AND OBJECTIVE: The aim of this study was to determine the efficacy of the cell salvage system in total hip arthroplasty surgeries and whether the cell salvage system can reduce the allogeneic blood transfusion requirement in total hip arthroplasty patients. METHODS: We reviewed retrospectively the medical records of patients who underwent hip arthroplasty surgeries between 2010 and 2012 in a university hospital. A total of 181 arthroplasty patients were enrolled in our study. RESULTS: In the cell salvage group, the mean perioperative rate of allogeneic blood transfusion was significantly lower (92.53 ± 111.88 mL) than that in the control group (170.14 ± 116.79 mL; p < 0.001). When the mean postoperative transfusion rates were compared, the cell salvage group had lower values (125.37 ± 193.33 mL) than the control group (152.22 ± 208.37 mL), although the difference was not statistically significant. The number of patients receiving allogeneic blood transfusion in the CS group (n = 29; 43.2%) was also significantly lower than control group (n = 56; 73.6%; p < 0.05). In the logistic regression analysis, perioperative amount of transfusion, odds ratio (OR) -4.257 (95% CI -0.502 to 0.184) and operation time, OR: 2.720 (95% CI 0.001-0.004) were independent risk factors for the usage of cell salvage system. CONCLUSION: Cell salvage is an effective strategy for reducing the need for allogeneic blood transfusion in the perioperative setting; it provides support to patient blood management interventions. Thus, we recommend the cell salvage system for use in total hip arthroplasty surgeries to reduce the need for allogeneic blood transfusion, if possible

Postoperative Analgesia for Arthroscopic Rotator Cuff Surgery: A Comparison Between Subacromial and Interscalene Levobupivacaine

Objectives: Arthroscopic rotator cuff surgery can result in severe postoperative pain. We compared a continuous subacromial infusion to a continuous interscalene block with levobupivacaine for patients undergoing arthroscopic rotator cuff surgery

Postoperative analgesia after arthroscopic shoulder surgery: A comparison between single-shot interscalene block and single-shot supraclavicular block.

Objectives: In arthroscopic rotator cuff surgery for postoperative analgesia opioids, nonsteroid analgesics, and local anesthetics can be used. This study aimed to compare the effectiveness, additional analgesic requirements, patients satisfaction, and complications of single-shot interscalene and supraclavicular blocks

SINGLE-CENTERED QUESTIONNAIRE STUDY: PROFESSIONAL ASSESSMENT AMONGST ANESTHESIOLOGY RESIDENTS

Objective: Anesthesiology is a special branch which requires different practice places, necessity for collaboration with various teams and frequently taking fast and right decisions. In this respect, stress is frequently experienced. It has been reported that unmanaged stress has become a worldwide concern for the anesthesiologists. In this study, we aimed to investigate the reasons for anesthesiology residents' professional satisfaction and stress during their training period and we have tried to identify the qualifications which a good anesthesiologist should have

THE COMPARISON OF LIDOCAINE WITH LIDOCAINE AND MAGNESIUM COMBINATION FOR REGIONAL INTRAVENOUS ANESTHESIA

Objectives: RIVA (Regional Intravenous Anesthesia) is frequently preferred during distal upper extremity operations (hand, wrist and forearm) compared to general anesthesia because of the following reasons: lower operational cost, simplicity, surgical operation environment stability, quick implementation and faster recovery time. Deeper anesthesia, prolonged effective time, hemodynamic stabilization, reduced intraoperative complications and longer postoperative analgesia are aimed by using adjunct drugs. Main objective of our study is to investigate the effectiveness of magnesium as an adjunct in RIVA

Early Diagnosis in Acute Kidney Failure: Neutrophil Gelatinase Associated Lipocain (NGAL), Kidney Injury Molecule-1 (KIM-1), Interleukine-18 (IL-18), Cystatin C

Objective: We aimed to evaluate the effectiveness of renal biomarkers (NGAL, KIM-1, IL-18, and Cystatin-C) for the diagnosis of acute kidney injury (AKI) in patients in intensive care unit (ICU)

Patient state index and cerebral blood flow changes during shoulder arthroscopy in beach chair position

Abstract Background and objectives: The aim of the study were to demonstrate the possible hemodynamic changes and cerebral blood flow alterations in patients who were positioned from supine to beach chair position; and to detect if the position change causes any cortical activity alteration as measured by the 4-channeled electroencephalography monitor. Methods: 35 patients were included. Before the induction, mean arterial pressure and patient state index values were recorded (T0). After the intubation, doppler-ultrasonography of the patients&#8217; internal carotid and vertebral arteries were evaluated to acquire cerebral blood flow values from the formula. In supine position, mean arterial pressure, patient state index and cerebral blood flow values were recorded (T1) and the patient was positioned to beach chair position. After 5 min all measurements were repeated (T2). Measurements of patient state index and mean arterial pressure were repeated after 20 (T3), and 40 (T4) min. Results: There was a significant decrease between T0 and T1 in heart rate (80.5 ± 11.6 vs. 75.9 ± 14.4 beats/min), MAP (105.8 ± 21.9 vs. 78.9 ± 18.4 mmHg) and PSI (88.5 ± 8.3 vs. 30.3 ± 9.7) (all p < 0.05). Mean arterial pressure decreased significantly after position change, and remained decreased, compared to T1. The overall analysis of patient state index values (T1-T4) showed no significant change; however, comparing only T1 and T2 resulted in a statically significant decrease in patient state index. There was a significant decrease in cerebral blood flow after beach chair position. Conclusion: Beach chair position was associated with a decrease in cerebral blood flow and patient state index values. Patient state index was affected by the gravitational change of the cerebral blood flow; however, both factors were not directly correlated to each other. Moreover, the decrease in patient state index value was transient and returned to normal values within 20 min