Discussion
muscle injuries, postoperative pain, neuroinflammation, TNF-α, neuropathic pain, pain, metabolic disturbance
METABOLIC DISTURBANCE, PATHOPHYSIOLOGY
This randomized, double-blind, placebo-controlled study showed a significant improvement in TH in patients undergoing ambulatory knee arthroscopy under general anaesthesia who received a single dose of IVL compared with 0.9 per cent normal saline. It was also found that IVL had beneficial effects on postoperative pain and quality of recovery at 24 h after surgery. In addition, IVL could reduce the haemodynamic changes and the release of TNF-α during the perioperative interval.During knee arthroscopic surgery, patients often experience an increase in BP, with or without increased HR, as the tourniquet on the affected thigh fills and for longer intervals of time. Deepening the level of anaesthesia does not have a good effect on this haemodynamic change. Usually, as the surgery progresses, the level of anaesthesia increases over time, and the pathological autonomic response to the tourniquet persists until the tourniquet is deflatedThe pathophysiology of TH remains unclear. There are currently two potential mechanisms to support the development of TH. First, the metabolic disturbance caused by tourniquet compression is the activation of the autonomic sympathetic nervous system, leading to increased pain and sympathetic impulses, the release of large amounts of plasma catecholamine levels, which in turn leads to increased HR and BPDewinter Regarding the quality of recovery, a meta-analysisThe role and underlying mechanism of lidocaine in inhibiting neuroinflammation in neuropathic pain have not been fully revealed. Zheng Y The opioid drugs used in this study were remifentanil and sufentanil, the latter is a long-acting anaesthetic and its half-life is shorter, so the time for anaesthesia and sedation is shorter. However, sufentanil is more liposoluble and reaches the central nervous system directly through the blood brain barrier so it has a stronger analgesic effect. A previous studyThis study has several limitations. First, the trial was not a multicentre study, which may make the results not universal. Second, a single dose of IVL was selected in this study, without the combination of the continuous intravenous infusion of lidocaine. In the future, it can be further explored whether a single dose of IVL combined with an infusion of IVL could bring more beneficial effects to patients undergoing arthroscopy. Third, assessments of long-term pain and functional outcomes such as postoperative vascular, nerve, muscle injuries are missing. Larger studies are needed to observe long-term outcomes in patients undergoing ambulatory arthroscopy.