Effect of the method of anesthetic aid on cellular immunity in periprosthetic infection of the hip joint: : a prospective open randomized study

Abstract

BACKGROUND: Periprosthetic infection after primary hip replacement is a serious complication. For the anesthetic support of revision operations, both general and neuroaxial anesthesia methods can be used. The question of choosing an anesthetic aid that, with adequate modulation of the operational stress response, would have a minimal immunosuppressive effect is relevant.

AIM: To examine the effect of general and combined spinal–epidural anesthesia during revision operations in patients with periprosthetic hip joint infection on the parameters of cellular immunity.

MATERIALS AND METHODS: An open prospective randomized study was performed on 25 patients (11 women and 14 men). The patients underwent surgical interventions of revision prosthetics with the replacement of all components of the prosthesis. Group 1 (n=10) underwent general anesthesia (GA), and group 2 (n=15) underwent surgery under combined spinal–epidural anesthesia (CSEA). The indices of cellular immunity, namely, CD4+, CD8+, CD4+/CD8+, and B-lymphocytes, were evaluated. Blood sampling was performed in the morning on the day of surgery and then on days 1, 3, 5, and 7 after surgery.

RESULTS: The CD4+ (%) level in the CSEA group was significantly higher than in the GA group on days 3 and 7 after surgery (p <0.05). Changes in the percentage of CD8+ lymphocytes, the immunoregulatory index, and the percentage of B-lymphocytes between the groups had no statistically significant differences.

CONCLUSION: The CD4+ (%) level in the CSEA group was significantly higher than that in the GA group on days 3 and 7 after surgery (p <0.05). Statistically significant differences in the dynamics of CD8+, immunoregulatory index, and B-lymphocytes were not found, which may indicate a lesser effect of the type of anesthesia on these indicators.

Keywords

general anesthesia / combined spinal–epidural anesthesia / periprosthetic infection / CD4+ / CD8+ / B-lymphocytes

References

[1] Kapadia BH, Berg RA, Daley JA, et al. Periprosthetic joint infection. Lancet. 2016;387(10016):386–394. doi: 10.1016/s0140-6736(14)61798-0

[2] Kapadia B.H., Berg R.A., Daley J.A., et al. Periprosthetic joint infection // Lancet. 2016. Vol. 387, N 10016. P. 386–394. doi: 10.1016/s0140-6736(14)61798-0

[3] Shubnyakov II, Tikhilov RM, Denisov AO, et al. What Has Changed in the Structure of Revision Hip Arthroplasty? Traumatology and Orthopedics of Russia. 2019;25(4):9–27. (In Russ). doi: 10.21823/2311-2905-2019-25-4-9-27

[4] Шубняков И.И., Тихилов Р.М., Денисов А.О., и др. Что изменилось в структуре ревизионного эндопротезирования тазобедренного сустава в последние годы? // Травматология и ортопедия России. 2019. Т. 25, № 4. С. 9–27. doi: 10.21823/2311-2905-2019-25-4-9-27

[5] Komarov RN, Mitrofanov VN, Novikov AV, Korolev SB. The treatment of infectious complications after hip replacement. Traumatology and Orthopedics of Russia. 2016;22(4):25–34. (In Russ). doi: 10.21823/2311-2905-2016-22-4-25-34

[6] Комаров Р.Н., Митрофанов В.Н., Новиков А.В., Королёв С.Б. Тактика лечения инфекционных осложнений после эндопротезирования тазобедренного сустава // Травматология и ортопедия России. 2016. Т. 22, № 4. С. 25–34. doi: 10.21823/2311-2905-2016-22-4-25-34

[7] Pu X, Sun JM. General anesthesia vs spinal anesthesia for patients undergoing total-hip arthroplasty: A meta-analysis. Medicine. 2019;98(16):e14925. doi: 10.1097/md.0000000000014925

[8] Pu X., Sun J.M. General anesthesia vs spinal anesthesia for patients undergoing total-hip arthroplasty: A meta-analysis // Medicine. 2019. Vol. 98, N 16. P. e14925. doi: 10.1097/md.0000000000014925

[9] Van Waesberghe J, Stevanovic A, Rossaint R, Coburn M. General vs. neuraxial anaesthesia in hip fracture patients: a systematic review and meta-analysis. BMC Anesthesiol. 2017;17(28):87. doi: 10.1186/s12871-017-0380-9

[10] Van Waesberghe J., Stevanovic A., Rossaint R., Coburn M. General vs. neuraxial anaesthesia in hip fracture patients: a systematic review and meta-analysis // BMC Anesthesiol. 2017. Vol. 17, N 28. P. 87. doi: 10.1186/s12871-017-0380-9

[11] Greimel F, Maderbacher G, Zeman F, et al. No Clinical Difference Comparing General, Regional, and Combination Anesthesia in HipArthroplasty: A Multicenter Cohort-Study Regarding Perioperative Pain Management and Patient Satisfaction. J Arthroplasty. 2017;32(11):3429–3433. doi: 10.1016/j.arth.2017.05.038

[12] Greimel F., Maderbacher G., Zeman F., et al. No Clinical Difference Comparing General, Regional, and Combination Anesthesia in HipArthroplasty: A Multicenter Cohort-Study Regarding Perioperative Pain Management and Patient Satisfaction // J Arthroplasty. 2017. Vol. 32, N 11. P. 3429–3433. doi: 10.1016/j.arth.2017.05.038

[13] Chepeleva MV, Kliushin NM, Ermakov AM, Kuznecova EI. Lymphocyte Populations in Patients with Periprosthetic Infection of the Hip Joint. Novosti Khirurgii. 2020;28(3):276–283. (In Russ). doi: 10.18484/2305-0047.2020.3.276

[14] Чепелева М.В., Клюшин Н.М., Ермаков А.М., Кузнецова Е.И. Популяции лимфоцитов у пациентов с перипротезной инфекцией тазобедренного сустава // Новости хирургии. 2020. Т. 28, № 3. С. 276–283. doi: 10.18484/2305-0047.2020.3.276

[15] Heim C, Vidlak D, Odvody J, et al. Human prosthetic joint infections are associated with myeloid-derived suppressor cells (MDSCs): Implications for infection persistence. J Orthop Res. 2018;36(6):1605–1613. doi: 10.1002/jor.23806

[16] Heim C., Vidlak D., Odvody J., et al. Human prosthetic joint infections are associated with myeloid-derived suppressor cells (MDSCs): Implications for infection persistence // J Orthop Res. 2018. Vol. 36, N 6. P. 1605–1613. doi: 10.1002/jor.23806

[17] Rossaint J, Zarbock A. Perioperative Inflammation and Its Modulation by Anesthetics. Anesth Analg. 2018;126(3):1058–1067. doi: 10.1213/ane.0000000000002484

[18] Rossaint J., Zarbock A. Perioperative Inflammation and Its Modulation by Anesthetics // Anesth Analg. 2018. Vol. 126, N 3. P. 1058–1067. doi: 10.1213/ane.0000000000002484

[19] Ezhevskaya AA, Prusakova ZhB, Maksimova LP, et al. Effects of epidural anesthesia on stress-induced immune suppression during major corrective spine surgery. Anesteziologiya i reanimatologiya. 2014;59(6):11. (In Russ).

[20] Ежевская А.А., Прусакова Ж.Б., Максимова Л.П., и др. Влияние эпидуральной анестезии на стрессиндуцированную иммуносупрессию при больших корригирующих операциях на позвоночнике // Анестезиология и реаниматология. 2014. Т. 59, № 6. С. 11.

[21] Fife BT, Pauken KE, Eagar TN. Interactions between programmed death-1 and programmed death ligand-1 promote tolerance by blocking the T cell receptor-induced stop signal. Nat Immunol. 2009;10(11):1185–1192. doi: 10.1038/ni.1790

[22] Fife B.T., Pauken K.E., Eagar T.N. Interactions between programmed death-1 and programmed death ligand-1 promote tolerance by blocking the T cell receptor-induced stop signal // Nat Immunol. 2009. Vol. 10, N 11. P. 1185–1192. doi: 10.1038/ni.1790

[23] Dang Y, Shi X, Xu W, Zuo M. The Effect of Anesthesia on the Immune System in Colorectal Cancer Patients. Can J Gastroenterol Hepatol. 2018;2018:7940603. doi: 10.1155/2018/7940603

[24] Dang Y., Shi X., Xu W., Zuo M. The Effect of Anesthesia on the Immune System in Colorectal Cancer Patients // Can J Gastroenterol Hepatol. 2018. N 2018. P. 7940603. doi: 10.1155/2018/7940603

[25] Lyuboshevskiy PA, Zabusov AV, Timoshenko AL, Korovkin DV. The limitation of metabolic and inflammatory alterations in post-surgery period: the role of field block anesthesia and analgesia. Medical Journal of the Russian Federation. 2013;19(5):15–19. (In Russ). doi: 10.17816/rmj38131

[26] Любошевский П.А., Забусов А.В., Тимошенко А.Л., Коровкин Д.В. Ограничение метаболических и воспалительных изменений в послеоперационном периоде: роль регионарной анестезии и анальгезии // Российский медицинский журнал. 2013. Т. 19, № 5. С. 15–19. doi: 10.17816/rmj38131

[27] Tylman M, Sarbinowski R, Bengtson J, et al. Inflammatory response in patients undergoing colorectal cancer surgery: the effect of two different anesthetic techniques. Minerva Anestesiol. 2011;77(3):275–282.

[28] Tylman M., Sarbinowski R., Bengtson J., et al. Inflammatory response in patients undergoing colorectal cancer surgery: the effect of two different anesthetic techniques // Minerva Anestesiol. 2011. Vol. 77, N 3. P. 275–282.

[29] Bel’tyukov PP, Mamedov AD. Otsenka funktsional’noi aktivnosti komponenta SZ sistemy komplementa pri vozdeistvii tiopentala in vitro. Uchenye zapiski. 2013;3:29–31. (In Russ).

[30] Бельтюков П.П., Мамедов А.Д. Оценка функциональной активности компонента СЗ системы комплемента при воздействии тиопентала in vitro // Ученые записки. 2013. № 3. С. 29–31.

[31] Tanatarov SZ, Neymark MI, Zhakupov RK. The condition of cell immunity in cancer patients with surgery according to intraoperative anesthesia. Medicine in Kuzbass. 2012;11(4):15–19. (In Russ).

[32] Танатаров С.З., Неймарк М.И., Жакупов Р.К. Состояние клеточного звена иммунитета у онкологических больных, подвергавшихся оперативным вмешательствам, в зависимости от интраоперационной анестезии // Медицина в Кузбассе. 2012. Т. 11, № 4. С. 15–19.

[33] Zhu R, Xiang J, Tan M. Effects of different anesthesia and analgesia on cellular immunity and cognitive function of patients after surgery for esophageal cancer. Minerva Chir. 2020;75(6):449–456. doi: 10.23736/s0026-4733.20.08283-8

[34] Zhu R., Xiang J., Tan M. Effects of different anesthesia and analgesia on cellular immunity and cognitive function of patients after surgery for esophageal cancer // Minerva Chir. 2020. Vol. 75, N 6. P. 449–456. doi: 10.23736/s0026-4733.20.08283-8

[35] Fu S, Qu P-S, Cai S-N. Effect of anesthetic methods on postoperative CD3+, CD4+ and CD4+CD25+ in patients with lung cancer undergoing radical operation. Oncol Lett. 2018;16(5):6547–6551. doi: 10.3892/ol.2018.9416

[36] Fu S., Qu P.-S., Cai S.-N. Effect of anesthetic methods on postoperative CD3+, CD4+ and CD4+CD25+ in patients with lung cancer undergoing radical operation // Oncol Lett. 2018. Vol. 16, N 5. P. 6547–6551. doi: 10.3892/ol.2018.9416

[37] Li B, Li Y, Tian S, et al. Anti-inflammatory Effects of Perioperative Dexmedetomidine Administered as an Adjunct to General Anesthesia: A Meta-analysis. Sci Rep. 2015;5:12342. doi: 10.1038/srep12342

[38] Li B., Li Y., Tian S., et al. Anti-inflammatory Effects of Perioperative Dexmedetomidine Administered as an Adjunct to General Anesthesia: A Meta-analysis // Sci Rep. 2015. N 5. P. 12342. doi: 10.1038/srep12342

[39] Velcic Brumnjak S, Rakovac I, Papez Kinkela D, et al. Postoperative Regional Analgesia Is Effective in Preserving Perforin-Expressing Lymphocytes in Patients After Total Knee Replacement. Med Sci Monit. 2018;24:5320–5328. doi: 10.12659/msm.909385

[40] Velcic Brumnjak S., Rakovac I., Papez Kinkela D., et al. Postoperative Regional Analgesia Is Effective in Preserving Perforin-Expressing Lymphocytes in Patients After Total Knee Replacement // Med Sci Monit. 2018. N 24. P. 5320–5328. doi: 10.12659/msm.909385

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