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Anesth Analg 2007;104:460-461
© 2007 International Anesthesia Research Society
doi: 10.1213/01.ane.0000253160.08211.a3

LETTER TO THE EDITOR

Section Editor:
Lawrence Saidman

Synovial Fluid Concentration of Prostaglandin E2 Correlates with Pain Intensity After Knee Arthroscopic Procedures

Leiv A. Rosseland, MD, PhD, Claus D. Krohn, MD, PhD, and Audun Stubhaug, MD, PhD

Department of Anaesthesiology; Rikshospitalet-Radiumhospitalet Medical Center; Oslo, Norway; l.a.rosseland{at}medisin.uio.no (Rosseland, Krohn) Department Group of Clinical Medicine; University of Oslo; Oslo, Norway; Department of Anaesthesiology; Rikshospitalet-Radiumhospitalet Medical Center; Oslo, Norway (Stubhaug)

To the Editor:

The relationship between inflammation and acute postoperative pain is not well understood. Substance P, which is released from primary sensory neurons early in the local inflammatory process, induces mast cell degranulation and the release of cytokines and nerve growth factor. Prostaglandin E2 (PGE2) is stimulated by proinflammatory cytokines.

Two randomized controlled trials (RCT) were performed of intraarticular analgesics in general anesthesia with remifentanil as the sole analgesic (1,2). After the surgery no analgesics were given until patients had at least moderate pain and were included in the trials. In a subgroup of 20 patients, synovial fluid (SF) samples were drawn during the first hour after surgery. In these 20 patients we have analyzed whether perceived pain correlated with SF concentrations of mediators of inflammation. After surgery, pain was assessed on a 5-point verbal rating scale every 10 min. When patients reported moderate pain, SF was aspirated from an intraarticular catheter (n = 10), and the patients were included in RCT (1,2). If no pain or only mild pain was experienced, SF was collected 1 h after surgery (n = 10). [For methods and results in the two RCTs see Refs. (1,2).]

Interleukin (IL)-1, IL-8, and substance P were increased in all SF samples but did not correlate positively with pain intensity. The PGE2 concentration was higher among patients with moderate pain compared with the patients with no or mild pain; 3428 pg/mL (SD = 2320) and 754 pg/mL (SD = 452), respectively (P = 0.020; Table 1).


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  		Table 1. Synovial Fluid Concentration

 

This suggests a relation between SF PGE2 concentration, inflammation, and pain intensity after knee arthroscopy. Further studies in this clinical acute pain model may confirm a central role of cyclooxygenase products in postoperative pain after knee arthroscopy.

REFERENCES

  1. Rosseland LA, Stubhaug A, Grevbo F, et al. Effective pain relief from IA saline with or without morphine 2 mg in patients with moderate-to-severe pain after knee arthroscopy. A randomized, double-blind controlled clinical study. Acta Anaesthesiol Scand 2003;47:732–8.[ISI][Medline]
  2. Rosseland LA, Helgesen KG, Breivik H, Stubhaug A. Moderate-to-severe pain after knee arthroscopy is relieved by intraarticular saline: a randomized controlled trial. Anesth Analg 2004;98:1546–51.[Abstract/Free Full Text]




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press