Peripheral Nerve Block Facilitates Acute Inflammatory Responses Induced by Surgical Incision in Mice
Peripheral Nerve Block Facilitates Acute Inflammatory Responses Induced by Surgical Incision in Mice
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DOI：
10.1097/aap.0000000000000458
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发表时间：
2016-06
影响因子：
5.1
通讯作者：
Tomotsugu Yamada;Maiko Hasegawa-Moriyama;Tae Kurimoto;Takayuki Saito;T. Kuwaki;Y. Kanmura
中科院分区：
文献类型：
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作者：
Tomotsugu Yamada;Maiko Hasegawa-Moriyama;Tae Kurimoto;Takayuki Saito;T. Kuwaki;Y. Kanmura
背景与目的周围神经阻滞麻醉可改善手术患者的早期恢复状况，包括控制术后疼痛、阿片类药物用量和住院时间。然而，PNB对创面炎症和修复过程的影响还没有得到充分的研究。因此，我们评估了在术后疼痛发展的急性期，PNB对切割组织局部炎症的影响。方法小鼠在足底切开前用0.5%罗比卡因麻醉坐骨神经。术后7d观察疼痛行为、中性粒细胞浸润、凋亡细胞吞噬功能和炎性介质基因诱导情况。结果0.5%罗比卡因对坐骨神经的阻断作用使手术切开后2小时内对机械刺激的戒断阈值和热刺激的潜伏期一过性增加，而切开后3小时后无明显变化。切开后Gr-1+中性粒细胞浸润和CD68+巨噬细胞吞噬TdT介导的dUTP缺口末端标记+凋亡细胞数明显增加。肿瘤坏死因子和前列腺素E2在切开部位表达上调。此外，急性炎症期后化解炎症、促进伤口愈合的脂氧合酶-15和血红素氧合酶-1的表达也增加。结论术前单用PNB可促进切口处中性粒细胞和巨噬细胞介导的急性期炎症反应，但不影响术后疼痛。周围神经阻滞可能在不改变伤害性反应的情况下，局部加速手术切开后的先天免疫反应。
Background and Objectives Anesthesia with peripheral nerve block (PNB) improves the early recovery profile of patients undergoing surgery, including the control of postoperative pain, opioid consumption, and the length of hospital stay. However, the influence of PNB on wound inflammation and the repair process has not been fully investigated. Therefore, we evaluated the effects of PNB on local inflammation of incised tissue in the acute phase of postoperative pain development. Methods Sciatic nerve block with 0.5% ropivacaine was performed before plantar incision in mice. Pain behavior, neutrophil infiltration, phagocytosis of apoptotic cells, and gene induction of inflammatory mediators were assessed for 7 days postoperatively. Results Sciatic nerve block with 0.5% ropivacaine treatment transiently increased the withdrawal threshold to mechanical stimuli and thermal latency for 2 hours after surgical incision, whereas no changes were observed from 3 hours after incision throughout the postoperative period. However, Gr-1+ neutrophil infiltration and the number of CD68+ macrophages engulfing TdT-mediated dUTP nick-end labeling+ apoptotic cells were significantly increased after incision. Tumor necrosis factor and prostaglandin E2 were up-regulated at the incised sites. In addition, the expressions of lipoxygenase-15 and heme oxygenase-1, which resolve inflammation and promote wound healing after the acute inflammatory phase, were increased. Conclusions Single PNB before incision promoted acute phase inflammation mediated by neutrophils and macrophages at the sites of incision, whereas postoperative pain was not altered. Peripheral nerve block might locally accelerate innate immune responses after surgical incision without altering the nociceptive profile.