Continuous, Intra-Articular Infusion of Bupivacaine After Total-Knee Arthroplasty May Lead to Potentially Toxic Serum Levels of Local Anesthetic

Hoeft, Mark A.; Rathmell, James P.; Dayton, Michael R.; Lee, Peter; Howe, James G.; Incavo, Stephen J.; Lawlis, John F.

doi:10.1016/j.rapm.2005.04.009

Cited by 6 publications

(4 citation statements)

References 5 publications

(3 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Similar methods and techniques used in the study have been reported by others. 4,9,12,15 -17,25 -33 However, this is the first study to our knowledge that compares these 2 specific regimens. Results of the study showed that the use of an IOPA injection was associated with a statistically significant decrease in hospital LOS by about 9 hours, from 75.9 hours with the IOIA infusion to 67.0 hours with the IOPA injection.…”

Section: Discussionmentioning

confidence: 99%

Comparison of 2 Methods of Local Anesthetic-Based Injection as Part of a Multimodal Approach to Pain Management After Total Knee Arthroplasty

Tietje

Davis

Rivey

2014

Journal of Pharmacy Practice

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Comparison of 2 Methods of Local Anesthetic-Based Injection as Part of a Multimodal Approach to Pain Management After Total Knee Arthroplasty

Tietje

Davis

Rivey

2014

Journal of Pharmacy Practice

View full text Add to dashboard Cite

show abstract

“…In the study by Fuhrer et al 39 , the very conservative lower threshold of 1.6 µg/ml as being toxic was set by the authors. Based on our search, we found one report of toxicity occurring at concentrations as low as 1.1 µg/ml 65. However, even the mildest toxic symptoms are unlikely to appear below plasma levels of 1.6 µg/ml 66,67 . Gupta et al used levobupivacaine in one trial and reported total and free medians of 2.2 and 0.04 µg/ml after 23 hours of infusion respectively, without any clinical toxicity 68 .…”

Section: Toxicitymentioning

confidence: 96%

Systemic Levels of Local Anaesthetic after Intra-Peritoneal Application – a Systematic Review

Kahokehr

Sammour

Vather

et al. 2010

Anaesth Intensive Care

View full text Add to dashboard Cite

There is a lack of cohesive reports on the systemic levels of local anaesthetic after intraperitoneal application. A comprehensive systematic review with no language restriction was conducted. Eighteen suitable articles were identified. Data were compiled and presented according to local anaesthetic agent. Intraperitoneal local anaesthetic has been studied in many different procedures, including open and laparoscopic surgery. A total of 415 patients were included for analysis. There were no cases of clinical toxicity. There were 11 (2.7%) cases with a systemic level above or close to a safe threshold (as determined by the report authors) in three trials utilising intraperitoneal local anaesthetic after laparoscopic cholecystectomy. Intraperitoneal lignocaine doses varied from 100 to 1000 mg, mean Cmax ranged from 1.01 to 4.32 µg/ml and mean Tmax ranged from 15 to 40 minutes. Intraperitoneal bupivacaine doses varied from 50 to 150 mg (weight based doses also reported), mean Cmax ranged from 0.29 to 1.14 µg/ml and mean Tmax ranged from 15 to 60 minutes. Intraperitoneal ropivacaine doses varied from 100 to 300 mg, mean Cmax ranged from 0.66 to 3.76 µg/ml and mean Tmax ranged from 15 to 35 minutes. The addition of adrenaline to intraperitoneal local anaesthetic almost halves systemic levels and prolongs Tmax. Intraperitoneal local anaesthetic results in detectable systemic levels in the perioperative setting. Despite a lack of clinical toxicity, careful attention to dose is still required to prevent potential systemic toxic levels. Clinicians should also consider the addition of adrenaline to intraperitoneal local anaesthetic solutions to further add to the systemic safety profile.

show abstract

“…In summary, the efficacy of LIA in improving short-term postoperative pain relief and reducing total narcotic consumption has been confirmed. No consensus has been reached regarding the best infiltration sites, volumes, or timings of LIA, 23,24 and additives of LIA are variable. For example, the addition of steroids and ketorolac has been questioned because of the potentially increased risk of intra-articular infection 25 and possible renal and gut toxicity, 2 respectively.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and weakness of local infiltration analgesia in total knee arthroplasty: a systematic review

Zhang

Shen

2018

J Int Med Res

View full text Add to dashboard Cite

Local infiltration analgesia has been widely used for pain relief in patients undergoing total knee arthroplasty. However, the effectiveness and major weakness of this technique have not been clarified; therefore, improvements in the technique have been limited. We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials and conducted a meta-analysis of randomized controlled trials comparing local infiltration analgesia with placebo infiltration in patients undergoing total knee arthroplasty. Fourteen trials involving 1305 knees were eligible. The results showed that local infiltration analgesia significantly reduced early perioperative pain and total narcotic consumption. However, postoperative functional outcomes were not significantly different between local infiltration analgesia and placebo. The pain-relieving effect of local infiltration analgesia was found to be strong but short in duration. In the future, modified delivery methods and formulas with longer durations of action and analgesia may provide a better environment for patients and therefore improve their function outcomes.

show abstract

Continuous, Intra-Articular Infusion of Bupivacaine After Total-Knee Arthroplasty May Lead to Potentially Toxic Serum Levels of Local Anesthetic

Cited by 6 publications

References 5 publications

Comparison of 2 Methods of Local Anesthetic-Based Injection as Part of a Multimodal Approach to Pain Management After Total Knee Arthroplasty

Comparison of 2 Methods of Local Anesthetic-Based Injection as Part of a Multimodal Approach to Pain Management After Total Knee Arthroplasty

Systemic Levels of Local Anaesthetic after Intra-Peritoneal Application – a Systematic Review

Effectiveness and weakness of local infiltration analgesia in total knee arthroplasty: a systematic review

Contact Info

Product

Resources

About