1. Continuous subcutaneous instillation of bupivacaine compared to saline reduces interleukin 10 and increases substance P in surgical wounds after cesarean delivery.
- Author
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Carvalho B, Clark DJ, Yeomans DC, and Angst MS
- Subjects
- Adult, California, Dinoprostone metabolism, Down-Regulation, Elective Surgical Procedures, Enzyme-Linked Immunosorbent Assay, Exudates and Transudates immunology, Female, Humans, Infusions, Subcutaneous, Nerve Growth Factor metabolism, Pain Measurement, Pain, Postoperative immunology, Pain, Postoperative prevention & control, Pregnancy, Sodium Chloride administration & dosage, Subcutaneous Tissue immunology, Time Factors, Treatment Outcome, Up-Regulation, Analgesia, Obstetrical, Anesthetics, Local administration & dosage, Bupivacaine administration & dosage, Cesarean Section, Exudates and Transudates drug effects, Inflammation Mediators metabolism, Interleukin-10 metabolism, Subcutaneous Tissue drug effects, Subcutaneous Tissue surgery, Substance P metabolism
- Abstract
Background: Recent evidence suggests that locally delivered local anesthetics may exert tissue-damaging effects such as chondrolysis after intraarticular injection. Alteration of the inflammatory response is a potential mechanism for local anesthetic-induced tissue toxicity. In this study, we tested the effects of continuous local anesthetic infiltration on the release of inflammatory and nociceptive mediators in skin wounds after cesarean delivery., Methods: Thirty-eight healthy women undergoing cesarean delivery with spinal anesthesia were enrolled in this study, and were randomized to receive subcutaneous surgical wound infiltration with bupivacaine 5 mg/mL or saline at 2 mL/h for 24 hours after cesarean delivery. Wound exudate was sampled at 1, 3, 5, 7, and 24 hours after cesarean delivery using a subcutaneous wound drain technique. Cytokines, chemokines, substance P, prostaglandin E(2), and nerve growth factor were assayed using multiplex Bio-Plex® (Bio-Rad, Hercules, CA) and enzyme-linked immunosorbent assays., Results: Bupivacaine wound infusion resulted in a significant decrease of interleukin 10 and increase of substance P in wounds compared with saline infusion (area under the 24-hour concentration-time curve; P < 0.001). No statistically significant differences were detected for other cytokines, nerve growth factor, and prostaglandin E(2)., Conclusions: This study demonstrates that the continuous administration of clinically used doses of bupivacaine into wounds affects the local composition of wound mediators. Observed changes in interleukin 10 are compatible with a disruption of antiinflammatory mechanisms. Whether such modulation combined with the release of the proinflammatory mediator substance P results in an overall proinflammatory wound response will require future studies of wound healing.
- Published
- 2010
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