The effect of intravenous ibuprofen on ischemia reperfusion injury after perioperative tourniquet in total knee arthroplasty patients

The Effect of Intravenous Ibuprofen on Ischemia Reperfusion Injury After Perioperative Tourniquet in Total Knee Arthroplasty Patients In orthopedic surgeries, pneumatic tourniquet is frequently used to provide a clean surgical area. Ischemia due to the use of tourniquet and the subsequent reperfusion cause oxidative stress in the organism. Oxidative stress is a contributor for postoperative morbidity. Some non-steroidal anti-inflammatory drugs (NSAIDs) perform their anti-inflammatory effects partially by binding active oxygen radicals in the inflammation site or by inhibiting their formation (4). In our study we aimed to evaluate the effects of intravenous ibuprofen on ischemia reperfusion injury in total knee replacement surgery patients by using oxidative stress parameters. Patients undergoing unilateral total knee arthroplasty under general anesthesia between 1st of July 2016 and 31st of December 2016 were enrolled in the study. Patients who were planned to have regional anesthesia were excluded from the study. Patients were randomly divided into two groups. Protocol number, age, gender, BMI, additional disease, drug use, tourniquet duration, hemoglobin value, additional analgesic requirement and application and postoperative first day adverse reactions of each patient were recorded in the follow up research form. For both of the patient groups TOS, TAS, paraoxanase, arylesterase, myeloperoxidase, catalase, ceruloplasmin, albumin, IMA and thiol disulfide balance tests were performed before the anesthesia, 45 minutes after the tourniquet application, 20 minutes after the tourniquet was lowered and in the postoperative 24 hours. Test results were analyzed statistically. When the findings were evaluated we observed that in patients with total knee arthroplasty antioxidants decreased and oxidants increased in both groups on the postoperative first day. This may be attributed to ischemia-reperfusion injury due to tourniquet. With the doses of iv ibuprofen we used in the study we found that the antioxidant parameters in the case group decreased more compared to the control group; showing that the drug has an adverse effect on the organism in the fight against oxidative stress, which is an undesirable effect. In order to evaluate this negative effect of iv ibuprofen, which is more and more involved in postoperative analgesia, it may be necessary to use different doses of this drug and perform studies in different surgeries. Keywords: Ischemia-Reperfusion, iv Ibuprofen, Oxidative Stress, Knee Arthroplasty, Non Steroidal Antiinflammatory Drugs