Purpose: Pneumatic tourniquets are used in total knee arthroplasty (TKA) for surgical field visualization and improved cementation; however, their use is controversial. This study aimed to assess the effects of tourniquet application on enhanced recovery post-TKA. Methods: A prospective randomized single-blinded trial assessed tourniquet’s effects on postoperative pain, swelling, and early outcome in TKA. One-hundred and two patients with knee osteoarthritis were randomized to full-course (FC) and second half-course (SHC) application ( n = 51/group). Tumor necrosis factor-alpha (TNF-α), C-C motif chemokine ligand 2(CCL-2), pentraxin-3 (PTX-3), prostaglandin E-2 (PGE-2), superoxide dismutase-1 (SOD-1), and myoglobin (Mb) were assessed by enzyme-linked immunosorbent assay, while the visual analog scale (VAS), range of motion (ROM), and thigh circumference growth rate were recorded. Results: Average tourniquet duration significantly differed between the SHC (37.5 ± 5.1 min) and FC (66.4 ± 7.2 min) groups ( p < 0.01); VAS and thigh circumference growth rate in the SHC group were much lower compared with the FC group, while ROM was higher within 48 h of tourniquet removal ( p < 0.01). Blood TNF-α, PTX3, CCL2, PGE2, SOD-1, and Mb were lower in the SHC group than the FC group ( p < 0.01). Additionally, intraoperative blood loss was significantly elevated in the SHC group than the FC group ( p < 0.01), with lower postoperative blood loss in the drain ( p = 0.001). Postoperative drainage volume was reduced in the SHC group compared with the FC group ( p < 0.01); five and two patients in the FC and SHC groups required blood transfusion, respectively ( p = 0.025). Hospital stay tended to be shorter in the SHC group ( p = 0.023), and no tourniquet-related complications were recorded. Conclusion: Improved therapeutic outcome was observed in the SHC group, indicating patients should routinely undergo TKA with SHC tourniquet application.
Tetrahydroxystilbene glucoside (THSG) is one of the active ingredients of
Polygonum multiflorum. It has been shown to exert a variety
of pharmacological effects, including antioxidant, anti-aging, and
anti-atherosclerosis. Because of its prominent anti-inflammatory effect, we
explored whether THSG had analgesic effect. In this study, we used a model of
chronic inflammatory pain caused by injecting complete Freund’s adjuvant into
the hind paw of mice. We found THSG relieved swelling and pain in the hind paw
of mice on a dose-dependent manner. In the anterior cingulate cortex, THSG
suppressed the upregulation of GluN2B-containing N-methyl-D-aspartate receptors
and the downregulation of GluN2A-containing N-methyl-D-aspartate receptors
caused by chronic inflammation. In addition, THSG increased Bcl-2 and decreased
Bax and Caspase-3 expression by protecting neuronal survival. Furthermore, THSG
inhibited the phosphorylation of p38 and the increase of nuclear factor κB
(NF-κB) and tumor necrosis factor α (TNF-α). Immunohistochemical staining
revealed that THSG blocked the activation of microglia and reduced the release
of proinflammatory cytokines TNF-α, interleukin 1β (IL-1β), and interleukin 6
(IL-6). In conclusion, this study demonstrated that THSG had a certain effect on
alleviating complete Freund’s adjuvant-induced chronic inflammatory pain.
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