Nociceptin/Orphanin is a novel opioid peptide system associated with inflammatory response. Currently is it uncertain as to the presence of absence of nociceptin in synovial fluid of patients. Nociceptin levels will be measured pre-operatively and post-operatively in plasma levels of patients receiving primary total knee arthroplasty. Nociceptin levels will also be measured in synovial fluid levels prior to surgical manipulation.
This is a prospective observational study where nociceptin levels will be drawn from the patient's serum as well as from the patient's synovial fluid. The blood draws will be completed by the anesthesia team and the synovial fluid and tissue will be obtained by the orthopedic team. The initial blood draw will be in the preoperative area and the second blood draw will be five minutes after the release of the tourniquet. The synovial fluid will be drawn by the surgeon with the first incision. There will be no randomization nor control group. Endpoints: 1. The level or absence of nociceptin in synovial fluid in patients receiving total knee primary arthroplasty will be measured via ELISA in picograms per volume. 2. The level or absence of nociceptin in plasma in patients receiving total knee primary arthroplasty both in the preoperative period (less than 1 hour prior to surgery and 5 minutes after the tourniquet is removed) via ELISA in picograms per volume. 3. Determine the changes if any of nociception plasma levels during the perioperative course of patients receiving total primary knee arthroplasty. Secondary Study Endpoints: 1. Determine the effect if present of history of chronic pain and opioid use on the levels of nociception present in patients' synovial fluid and plasma receiving primary total knee arthroplasty. 2. Determine the effect if present of demographic factors on the levels of nociception present in patients' synovial fluid and plasma receiving primary total knee arthroplasty
Study Type
OBSERVATIONAL
Enrollment
22
Nociceptin in Synovial Fluid
The level or absence of nociceptin in synovial fluid will be measured using ELISA and represented in picograms per volume.
Time frame: The surgeon will make a small incision after the patient has been anesthetized and prepped and draped. He will then withdraw the synovial fluid and then will begin the surgery after the fluid is removed.
Nociceptin in Plasma
Determine the presence of absence of nociceptin in plasma in patients receiving total knee primary arthroplasty and determine the changes if any of nociception plasma levels during the perioperative course of patients receiving total primary knee arthroplasty. Nociceptin will be measured using ELISA and represented in terms of picograms per volume.
Time frame: Blood will be drawn in the preoperative period (approximately up to 1 hour prior to surgery).
Nociceptin in Plasma
Determine the presence of absence of nociceptin in plasma in patients receiving total knee primary arthroplasty and determine the changes if any of nociception plasma levels during the perioperative course of patients receiving total primary knee arthroplasty. Nociceptin will be measured using ELISA and represented in terms of picograms per volume.
Time frame: Blood will be drawn 5 minutes after the release of the tourniquet.
Patient Demographics
Age
Time frame: Will be determined in the preoperative period up to one hour prior to surgery.
Patient Demographics
Gender
Time frame: Will be determined in the preoperative period up to one hour prior to surgery.
Patient Demographics
BMI
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Time frame: Will be determined in the preoperative period up to one hour prior to surgery
Patient Pain Scores
pre-operative pain scores will be determined using the 0-10 verbal analog scale.
Time frame: One set of preoperative scores will be obtained up to one hour prior to surgery.
Patient Pain Scores
post-operative pain scores will be determined using the 0-10 verbal analog scale.
Time frame: One set of post operative pain scores will be obtained up to one hour post emergence from anesthesia.