title: Temperature-sensitive release of prostaglandin E₂ and diminished energy requirements in synovial tissue with postoperative cryotherapy: a prospective randomized study after knee arthroscopy.
abstract: BACKGROUND
  Local external cooling of the surgical field after joint surgery is intended to enhance recovery and to facilitate the use of outpatient surgery by reducing pain and improving mobility. We hypothesized that the effects of postoperative cooling and compression after knee arthroscopy would be reflected in changes in the concentrations of metabolic and inflammatory markers in the synovial membrane.
  
  
  METHODS
  Forty otherwise healthy patients who were to undergo knee arthroscopy were included in the study, and half were randomized to receive postoperative cooling and compression. Microdialysis of the synovial membrane was performed postoperatively, and the concentrations of prostaglandin E₂ (PGE₂), glucose, lactate, glycerol, and glutamate as well as the ethanol exchange ratio (which indicates blood flow) were measured. The temperature of the knee was monitored, and postoperative pain was assessed by the patient with use of a visual analog scale, a numeric rating scale, and the need for rescue medication.
  
  
  RESULTS
  Application of the cooling and compression device after knee arthroscopy significantly lowered the temperature in the operatively treated knee (as measured on the skin, within the joint capsule, and intra-articularly). The cooling and compression appeared to decrease inflammation, as indicated by a temperature-sensitive decrease in the PGE₂ concentration. The hypothermia also decreased the metabolic rate of the synovial tissue and thus decreased energy requirements, as shown by the stability of the lactate concentration over time despite the decreased blood flow that was indicated by the increasing ethanol exchange ratio. No effect of the compression and cooling on postoperative pain was detected.
  
  
  CONCLUSIONS
  Local cryotherapy and compression after knee arthroscopy significantly lowered the temperature in the knee postoperatively, and the synovial PGE₂ concentration was correlated with the temperature. Since PGE₂ is a marker of pain and inflammation, the postoperative local cooling and compression appeared to have a positive anti-inflammatory effect.
authors: Division of Orthopedics, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Huddinge, Stockholm, Sweden. anders.stalman@ki.se
authors: Anders
authors: A
authors: Stålman
authors: Lukas
authors: L
authors: Berglund
authors: Elisabeth
authors: E
authors: Dungnerc
authors: Peter
authors: P
authors: Arner
authors: Li
authors: L
authors: Felländer-Tsai
mesh_terms: D000328:Adult; D000368:Aged; D001182:Arthroscopy / Q000009:adverse effects / Q000379:methods*; D015415:Biomarkers / Q000378:metabolism; D001831:Body Temperature / Q000502:physiology; D058128:Compression Bandages; D017679:Cryotherapy / Q000379:methods*; D015232:Dinoprostone / Q000378:metabolism*; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000628:therapy; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D018570:Risk Assessment; D013583:Synovial Membrane / Q000378:metabolism*; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D015232:Dinoprostone