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15 March 2013

Cervical sympathetic block regulates early systemic inflammatory response in severe trauma patients

Ming-Hua LiuACDEFG, Jun TianBCEF, Yong-Ping SuAG, Tao WangB, Qiang XiangD, Liang WenD

DOI: 10.12659/MSM.883833

Med Sci Monit 2013; 19:194-201

Abstract

BACKGROUND: This aim of this study was to investigate the effects of one-side cervical sympathetic block on early inflammatory response in severe trauma patients.

MATERIAL AND METHODS: Thirty severe trauma patients with injury severity score (ISS) of 16 to 25 were randomly divided into treatment and control groups (n=15 each). Patients in the treatment group underwent a right-side stellate ganglion block (SGB) using 8 mL 0.75% ropivacaine for 4 times, with the first injection within 12 hr of admission and the other 3 injections were 12 hr, 24 hr and 48 hr later. The same procedures were performed for the control group except that normal saline was injected instead of ropivacaine. Blood was collected before injection and at 6 hr, 24 hr, and 72 hr after the first SGB for serum interleukin (IL)-1beta, IL-4, IL-6, IL-10 and TNF-alpha measurement.

RESULTS: The concentrations of IL-1beta, IL-6, and TNF-alpha between 24 hr to 72 hr after SGB were all significantly lower than those in the control group (all P values <0.01). However, there was no significant difference in the concentrations of anti-inflammatory IL-4 and IL-10 between treatment and control groups. There was no obvious impact of SGB on breathing and circulation except for a slower heart rate 10 to 50 min after injection (P<0.01).

CONCLUSIONS: SGB regulates early inflammatory response through inhibition of the proinflammatory cytokines IL-1beta, IL-6, and TNF-alpha during severe trauma. SGB has no impact on the levels of anti-inflammatory cytokines IL-4 and IL-10.

Keywords: Respiration - drug effects, Inflammation Mediators - blood, Inflammation - physiopathology, Cytokines - blood, Cervical Vertebrae - physiopathology, Case-Control Studies, Autonomic Nerve Block, Amides - pharmacology, Stellate Ganglion - drug effects, Wounds and Injuries - therapy, young adult

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750