Effect of Ultrasound-Guided Fascia Iliac Compartment Block on Serum NLRP3 and Inflammatory Factors in Patients with Femoral Intertrochanteric Fracture

Abstract

Objective. To investigate the effects of ultrasound-guided fascia iliac compartment block (FICB) on patients’ postoperative pain and inflammatory factors as well as nucleotide-binding domain and leucine-rich repeat (NLR) family, pyrin domain-containing 3 (NLRP3) in femoral intertrochanteric fracture. Methods. This single-blind randomized controlled study included 231 patients with femoral intertrochanteric fracture treated in our hospital from January 2017 to December 2020. All patients were randomized into two groups, the FICB group ( n = 116 ) and the general anesthesia group (control group, n = 115 ). The serum NLRP3 levels and inflammatory factors were evaluated. The heart rate (HR), mean arterial pressure (MAP), and SpO2 values were recorded. Pain condition was measured by the visual analogue scale (VAS) score. Harris score was performed for positive hip function. Results. The values of HR and MAP were significantly lower after anesthesia induction in FICB groups compared with the control group. However, no significant difference was found for SpO2. Compared with the control group, the VAS scores within 72 h after surgery were all markedly lower in the FICB group than in the control group and showed no significant difference at 1 week after surgery. The levels of NLRP3 and interleukin 6 (IL-6) were significantly lower in FICB patients at 1 h, 6 h, 24 h, 48 h, and 72 h after surgery compared with the control group. Tumor necrosis factor-α (TNF-α) showed a significant lower level in the FICB group at 1 h and 6 h after surgery, and significant lower levels of C-reactive protein (CRP) were found at 1 h and 24 h after surgery compared with the control group. Positive correlation was found between NLRP3 and IL-6, as well as CRP and VAS scores after 1 h of the surgery. No significant difference was found for both Harris score and postoperative complications between the two groups. Conclusion. Fascia iliac compartment block could reduce the postoperative pain, which might be associated with the decrease of the serum levels of NLRP3, CRP, IL-6, and TNF-α in femoral intertrochanteric fracture patients.

Interactions and Trends of Interleukins, PAI-1, CRP, and TNF-α in Inflammatory Responses during the Perioperative Period of Joint Arthroplasty: Implications for Pain Management—A Narrative Review

“…A positive correlation was also observed between CRP levels and Visual Analog Scale (VAS) scores 1 h post-surgery (p < 0.05). Conversely, no significant correlations were detected between VAS scores and other inflammatory markers, including CRP, IL-6, and TNF-α [199].…”

“…Zhu K. et al performed a randomized control study to investigate the role of FICB on postoperative pain and inflammatory factors including NLRP3 in patients with femoral intertrochanteric fractures [199]. The dynamic alterations and association between NLRP3 and inflammatory markers were analyzed in both cohorts of patients.…”

“…Therefore, the local infiltration of ketorolac and local anesthetics may reduce pain intensity by exerting local anti-inflammatory effects. This partly explains the known analgesic effect of local infiltration analgesia (LIA) [199,226,227,[241][242][243][244][245].…”

“…In addition to the use of analgesics and nonsteroidal anti-inflammatory drugs in the management of pain associated with surgeries, the application of fascia iliac compartment block (FICB) has been reported in several surgeries to obtain good results, such as total hip arthroplasty and fracture management [195][196][197][198][199]. The activation of inflammation-related factors during pain is associated with the development of pain.…”

“…The NLRP3 inflammasome is a key component of the innate immune system that regulates the production of pro-inflammatory cytokines, such as IL-1β, which are vital in the inflammatory process. Managing these inflammatory factors can be critical for controlling postoperative pain and enhancing healing [50,[199][200][201][202][203].…”