Acta Chir Orthop Traumatol Cech. 2023; 90(5):314-322 | DOI: 10.55095/achot2023/037
Effect of Remote Ischemic Preconditioning in Total Knee Arthroplasty on Thiol-Disulfide Balance: a Randomized Controlled StudyOriginal papers
- 1 Department of Anesthesiology and Reanimation, Konya City Hospital, University of Health Science, Konya, Turkey
- 2 Baskent University, Department of Orthopedics and Traumatology, Konya, Turkey
- 3 Ankara Yildirim Beyazit University, Department of Clinical Biochemistry, Ankara, Turkey
- 4 Outcomes Research Consortium, Cleveland Clinic, OH, USA
- 5 Ohio University Heritage College of Osteopathic Medicine, Cleveland Campus, OH, USA
Purpose of the study: The purpose of this study was to minimize tourniquet-induced ischemia-reperfusion injury (IRI) in total knee arthroplasty (TKA) surgery using the remote ischemic preconditioning (RIPC) model, as well as to assess antioxidant balance with thiol-disulfide homeostasis (TDH). The secondary goal is to evaluate the impact of RIPC on TKA clinical outcomes.
Material and Methods: Patients in the ASA I-III group who underwent elective TKA were enrolled in this prospective, randomized, double-blind clinical research. TDH parameters were measured individually in groups with (Group I) and without (Group K) RIPC at the following times: preoperative (T0), right before the pneumatic tourniquet was opened (T1), 1 (T2), 6 (T3), and 24 (T4) hours after it was opened. In addition, at 3-hour intervals, the postoperative pain level was assessed using a visual analog scale (VAS).
Results: This study included 60 cases (Group K; n=30, Group I; n=30). Both groups had equal native thiol, total thiol, disulfide levels, disulfide/native thiol, disulfide/total thiol, and native thiol/total thiol ratios (p>0.05 for each). The change in native thiol, total thiol, and disulfide values at T0 and T4 periods, however, was not statistically significant for Group K (p=0.049, p=0.047, p=0.037, and p=0.217, p=0.191, p=0.220, respectively). At the 15th hour, VAS values in group I were considerably lower than in Group K (p=0.002).
Discussion: This prospective, randomized, controlled trial examined how RIPC affected tourniquet-induced IRI-induced oxidative stress in TKA surgery. Lower native, total, and disulfide levels at each postoperative time point were significant. RIPC may reduce tourniquet-induced IRI-induced oxidative stress and TDH in TKA surgery. RIPC also reduced postoperative discomfort.
Conclusions: Our findings suggest that RIPC may protect against the oxidative stress caused by IRI during limb surgery with a tourniquet and improve postoperative clinical outcomes.
Keywords: remote ischemic preconditioning, ischemia-reperfusion injury, thiol-disulfide balance, oxidative stress, total knee arthroplasty.
Published: November 11, 2023 Show citation
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