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Z Orthop Unfall 2020; 158(01): 41-45
DOI: 10.1055/a-0918-6603
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Influence of Postoperative Patient-Controlled Analgesia on Hemorheology in Patients Undergoing Hip Arthroplasty

PCA on HemorheologyEinfluss der postoperativen patientengesteuerten Analgesie (PCA) auf die Hämorheologie bei Patienten nach HüftarthroplastikEinfluss der PCA auf die Hämorheologie
Yiping Bai
1   Anesthesiology, Affiliated Hospital of Southwest Medical University, Luzhou, China
,
Liqun Mo
1   Anesthesiology, Affiliated Hospital of Southwest Medical University, Luzhou, China
,
Liming Luan
2   Vanderbilt University Medical Center, Department of Anesthesiology, Nashville, United States
,
Daiying Zhang
3   Department of Operating Room, Affiliated Hospital of Southwest Medical University, Luzhou, China
› Author Affiliations
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Publication History

Publication Date:
25 September 2019 (online)

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Abstract

Objective To test the hypothesis that patient-controlled analgesia (PCA) contributes to improvement of hemorheology in patients undergoing hip arthroplasty.

Methods 120 patients, aged 60 – 75 years old, undergoing hip arthroplasty under spinal anesthesia, were randomly divided into group PCA (n = 60) and control group (n = 60). Patients in PCA group received PCA in postoperative 3 days. Blood samples from the median cubital vein were collected at five time points: before anesthesia (T1), after surgery (T2), 6 h after surgery (T3), 24 h after surgery (T4), 48 h after surgery (T5). Hemorheological parameters were measured, including whole blood viscosity at a high shear rate (Hηb), whole blood viscosity at a low shear rate (Lηb), reduced viscosity (ηr), plasma viscosity (ηp), hematocrit (Hct), erythrocyte aggregation index(EAI) and erythrocyte deformation index (EDI). Noninvasive blood pressure and heart rate at T1-5 and pain scoring of visual analogue scale (VAS) score at T2-5 were recorded.

Results (1) Compared with T1, Hηb, Lηb, ηp, ηr decreased significantly at T3–5 with EAI decreased significantly at T5 in group PCA (p < 0.05), EDI increased significantly at T5 in group C (p < 0.05). (2) Compared with group C, Hηb, Lηb, ηp, ηr, EAI decreased significantly at T5 with Lηb concurrently decreased at T4 in group PCA (p < 0.05).

Conclusion Postoperative pain may increase blood viscosity in patients undergoing hip arthroplasty, mainly via plasma viscosity, erythrocyte aggregation and rigidity, and which could be improved by postoperative PCA.

Zusammenfassung

Ziel Prüfung der Hypothese, dass die patientengesteuerte Analgesie (PCA) bei Patienten nach Hüftarthroplastik zur Verbesserung der Hämorheologie beiträgt.

Methoden 120 Patienten im Alter von 60 – 75 Jahren, die sich einer Hüftarthroplastik unter Spinalanästhesie unterzogen, wurden per Randomisierung der PCA-Gruppe (n = 60) bzw. der Kontrollgruppe (n = 60) zugewiesen. Patienten der PCA-Gruppe wurden postoperativ über 3 Tage mittels PCA behandelt. Zu fünf Zeitpunkten wurden Blutproben aus der Ellenbeugenvene entnommen: vor der Anästhesie (T1), nach der Operation (T2), 6 h nach der Operation (T3), 24 h nach der Operation (T4) und 48 h nach der Operation (T5). Als hämorheologische Parameter wurden die Viskosität des Vollbluts bei hoher Schergeschwindigkeit (Hηb), die Viskosität des Vollbluts bei geringer Schergeschwindigkeit (Lηb), die reduzierte Viskosität (ηr), die Plasmaviskosität (ηp), der Hämatokrit (Hct) sowie der Erythrozytenaggregationsindex (EAI) und der Erythrozytendeformationsindex (EDI) erhoben. Zudem wurden nichtinvasive Blutdruck- und Herzfrequenzmessungen zu den Zeitpunkten T1 – 5 sowie Schmerzbeurteilungen anhand einer visuellen Analogskala (VAS) zu den Zeitpunkten T2 – 5 aufgezeichnet.

Ergebnisse (1) In der PCA-Gruppe hatten sich die Parameter Hηb, Lηb, ηp und ηr zu den Zeitpunkten T3 – 5 und der EAI zum Zeitpunkt T5 signifikant vermindert, jeweils gegenüber Zeitpunkt T1 (p < 0,05); in der Kontrollgruppe hatte sich der EDI zum Zeitpunkt T5 signifikant erhöht (p < 0,05). (2) Im Vergleich zur Kontrollgruppe wurde in der PCA-Gruppe zum Zeitpunkt T5 eine signifikante Verminderung der Parameter Hηb, Lηb, ηp, ηr und EAI bei gleichzeitiger Verminderung der Lηb zum Zeitpunkt T4 beobachtet (p < 0,05).

Schlussfolgerung Bei Patienten, die sich einer Hüftarthroplastik unterziehen, können postoperative Schmerzen die Blutviskosität erhöhen, überwiegend über die Plasmaviskosität, Erythrozytenaggregation und -rigidität, was sich mittels postoperativer PCA verbessern ließ.

Key words

hemorheology - patient-controlled - analgesia - hip arthroplasty

Schlüsselwörter

Hämorheologie - patientengesteuert - Analgesie - Hüftarthroplastik
 

  • References

  • 1 Anderson FA, Spencer FA. Risk factors for venous thromboembolism. Circulation 2003; 107 (23 Suppl. 1): I-9-I-16
    PubMedGoogle Scholar
  • 2 Wood M, Mantilla CB, Horlocker TT. et al. Frequency of myocardial infarction, pulmonary embolism, deep venous thrombosis, and death following primary hip or knee arthroplasty. Anesthesiology 2002; 96: 1140-1146
    CrossrefPubMedGoogle Scholar
  • 3 Cetin M, Cetin E, Ozeke O. et al. Whole blood viscosity predicts the definite stent thrombosis after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Eur Heart J 2015; 36: 351
    PubMedGoogle Scholar
  • 4 López JM, Fortuny G, Puigjaner D. et al. Effects of walking in deep venous thrombosis: a new integrated solid and fluid mechanics model. Int J Numer Method Biomed Eng 2017; DOI: 10.1002/cnm.2819.
    CrossrefPubMedGoogle Scholar
  • 5 Beilin B, Mayburd E, Yardeni I-Z. et al. Blood rheology in PCA and PCEA after total knee arthroplasty. J Arthroplasty 2006; 21: 179-184
    CrossrefPubMedGoogle Scholar
  • 6 Lou X, Yan M. Effect of different analgesia combined with low molecular heparin on hemorheology and coagulation in patients undergoing total hip replacement. Zhonghua Yi Xue Za Zhi 2010; 90: 1171-1176
    PubMedGoogle Scholar
  • 7 Webb CA, Weyker PD, Esenther B, Mathew L. Acute Postsurgical Pain and PCA Management. In: Pain Management and Palliative Care. New York, NY: Springer; 2015: 253-263
    CrossrefGoogle Scholar
  • 8 Sankaran S, Kim HJ, Choi G. et al. Uncertainty quantification in coronary blood flow simulations: impact of geometry, boundary conditions and blood viscosity. J Biomech 2016; 49: 2540-2547
    CrossrefPubMedGoogle Scholar
  • 9 Secomb TW. Blood flow in the microcirculation. Annu Rev Fluid Mech 2017; 49: 443-461
    CrossrefPubMedGoogle Scholar
  • 10 Kwaan HC. Role of plasma proteins in whole blood viscosity: a brief clinical review. Clin Hemorheol Microcirc 2010; 44 (03) 167-176
    CrossrefPubMedGoogle Scholar
  • 11 Windberger U, Pöschl C, Peters S. et al. Measurement of whole blood of different mammalian species in the oscillating shear field: influence of erythrocyte aggregation. J Phys: Conf Ser 2017; 790: 012035
    CrossrefPubMedGoogle Scholar
  • 12 Ulker P, Özen N, Basralı F. et al. Acute and Short Term Hyperoxemia: How about Hemorheology and Tissue Perfusion?. J Intensive Crit Care 2017; 3: 18
    PubMedGoogle Scholar
  • 13 Li XS, Cheng SJ, Cao ZG. et al. Elevated whole blood viscosity in patients with lumbar disc herniation. Clin Hemorheol Microcirc 2016; 62: 291-298
    PubMedGoogle Scholar
  • 14 Brown R, Chevalier G. Grounding the human body during yoga exercise with a grounded yoga mat reduces blood viscosity. Open J Prev Med 2015; 5: 159
    PubMedGoogle Scholar
  • 15 Nebor D, Bowers A, Hardy-Dessources M-D. et al. Frequency of pain crises in sickle cell anemia and its relationship with the sympatho-vagal balance, blood viscosity and inflammation. Haematologica 2011; 96: 1589-1594
    CrossrefPubMedGoogle Scholar
  • 16 Litvinov RI, Weisel JW. Role of red blood cells in haemostasis and thrombosis. ISBT Sci Ser 2017; 12: 176-183
    CrossrefPubMedGoogle Scholar
  • 17 Smart TJ, Richards CJ, Bhatnagar R. et al. A study of red blood cell deformability in diabetic retinopathy using optical tweezers. Proc SPIE 2015; 2015: 954825
    PubMedGoogle Scholar
  • 18 Sebastian B, Dittrich PS. Microfluidics to Mimic Blood Flow in Health and Disease. Annu Rev Fluid Mech 2018; 50: 483-504
    CrossrefPubMedGoogle Scholar
  • 19 Jung F, Rampling M. Role of blood viscosity in the microcirculation. Clin Hemorheol Microcirc 2016; 64: 251-254
    PubMedGoogle Scholar
  • 20 Korsten P, Niewold TB, Zeisberg M. et al. Increased Whole Blood Viscosity Is Associated with the Presence of Digital Ulcers in Systemic Sclerosis: Results from a Cross-Sectional Pilot Study. Autoimmune Dis 2017; 2017: 3529214
    PubMedGoogle Scholar