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Original Research

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Lumbar epidural analgesia and sciatic and femoral peripheral nerve blocks attenuate the stress-induced response in patients during the early postoperative period following total knee replacement

  • Vlatka Sotošek1,2,3,*,†,
  • Sandra Velčić Brumnjak4,†
  • Krešimir Bukal4
  • Dijana Papež Kinkela4
  • Danijel Lopac4
  • Nikola Gržalja4
  • Merica Aralica5
  • Tanja Batinac3
  • Lara Batičić6

1Clinic for Anesthesia, Intensive Care Medicine and Pain Management, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia

2Department of Anesthesiology, Reanimatology, Emergency and Intensive Care Medicine, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia

3Department of Clinical Medical Studies I, Faculty of Health Sciences, University of Rijeka, 51000 Rijeka, Croatia

4Clinic for Orthopedics and Traumatology Lovran, 51415 Lovran, Croatia

5Clinical Institute of Laboratory Diagnostics, Clinical Hospital Centre Rijeka, 51000 Rijeka, Croatia

6Department of Medical Chemistry, Biochemistry and Clinical Chemistry, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia

DOI: 10.22514/sv.2024.002 Vol.20,Issue 1,January 2024 pp.35-42

Submitted: 21 June 2023 Accepted: 21 July 2023

Published: 08 January 2024

*Corresponding Author(s): Vlatka Sotošek E-mail:

† These authors contributed equally.


Invasive surgical procedures cause immune system downregulation by inducing a profound proinflammatory response. Establishing the most effective type of postoperative analgesia is crucial to maintain the equilibrium of the immune system. The purpose of this research was to evaluate the influence of epidural analgesia, peripheral nerve blockade as well as systemic analgesia on stress response in patients during the early postoperative period following total knee replacement. In total, 60 patients undergoing total knee replacement were allocated into three groups (n = 20, per group) in this prospective randomized study. Group 1, Group 2 and Group 3 received epidural analgesia, sciatic and femoral peripheral nerve blocks and systemic analgesia, respectively. Intensity of pain was measured at rest and upon movement. Blood samples were collected at baseline (T0), immediately before (T1) and after (T2) surgery, and 24 (T3) and 72 (T4) h postoperatively. The absolute number of leukocytes, concentrations of catecholamine, cortisol and C-reactive protein were determined. Patients in Group 1 and Group 2 exhibited lower pain scores than Group 3. Concentrations of cortisol and norepinephrine, but not epinephrine, were significantly lower in Group 1 and Group 2 at T2 than in Group 3. Significantly lower interleukin-1β concentrations were observed in Group 1 and Group 2 at T3 and T4 than in Group 3. Interleukin-6 concentrations were minor in Group 1 and Group 2 at T2 than in Group 3. Lumbar epidural analgesia and sciatic and femoral peripheral nerve blocks are effective analgesic techniques that reduce the acute inflammatory stress response in patients during the early postoperative period following total knee replacement.


Analgesia; Cytokines; Hormones; Pain; Stress response; Total knee replacement

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Vlatka Sotošek,Sandra Velčić Brumnjak,Krešimir Bukal,Dijana Papež Kinkela,Danijel Lopac,Nikola Gržalja,Merica Aralica,Tanja Batinac,Lara Batičić. Lumbar epidural analgesia and sciatic and femoral peripheral nerve blocks attenuate the stress-induced response in patients during the early postoperative period following total knee replacement. Signa Vitae. 2024. 20(1);35-42.


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