Serum and Wound Drain Ropivacaine Concentrations After Wound Infiltration in Joint Arthroplasty

Stringer, Bruce W.; Singhania, Aloke K.; Sudhakar, Joe E.; Brink, Rodney B.

doi:10.1016/j.arth.2006.09.004

Cited by 27 publications

(16 citation statements)

References 24 publications

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“…Serum concentrations ranged from 0.23 to 1.5 g/mL, which is in the same order of magnitude as hitherto reported after wound infiltration or epidural administration of ropivacaine [27]. Drainage volumes were also in agreement with previous observations [1,2]. In Parker et al's study drainage volumes varied from 300 to 700 mL (mean: 412 mL) and Stinger et al reported drainage volumes ranging from 59 to 1015 mL in knee arthroplasty (mean 465 mL) and from 70 to 500 mL in hip arthroplasty (mean 233 mL).…”

Section: Resultssupporting

confidence: 90%

“…However, in patients receiving LIA, reinfusion of drainage blood implies risk of central nervous system (CNS) or cardiovascular system (CVS) toxicity due to potentially toxic concentrations of ropivacaine. By researching this subject, Stringer et al showed data that strongly indicated the safety of reinfusion [1] and recently Parker et al published the first promising results from a study among a few otherwise healthy patients receiving reinfusion after knee arthroplasty [2]. However, knee and hip arthroplasty is often performed among elderly and patients with significant comorbidity and the safety of routine blood reinfusion involving such patients has hitherto not been studied.…”

Section: Introductionmentioning

confidence: 99%

“…Analytical methods for ropivacaine in biosamples have mainly been based upon sample preparation by liquid/liquid extraction [1][2][3][4], protein precipitation (PPT) [5,6], solid-phase extraction (SPE) [7], solid-phase micro-extraction (SPME) [8] or molecular imprintbased solid-phase extraction (MISPE) [9]. Separation was done by gas chromatography with either nitrogen-phosphorous detection (GC-NPD) or mass spectrometric detection (GC-MS) [8,[10][11][12] or by high-performance liquid chromatography with either ultra violet detection (HPLC-UV) [1-4,] or mass spectrometric detection (HPLC-MS, HPLC-MS/MS) [5][6][7]9,13].…”

Section: Introductionmentioning

confidence: 99%

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Column-switching HPLC–MS/MS analysis of ropivacaine in serum, ultrafiltrate and drainage blood for validating the safety of blood reinfusion

Breindahl

Simonsen

Andreasen

2010

Journal of Chromatography B

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Section: Resultssupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Column-switching HPLC–MS/MS analysis of ropivacaine in serum, ultrafiltrate and drainage blood for validating the safety of blood reinfusion

Breindahl

Simonsen

Andreasen

2010

Journal of Chromatography B

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“…An option that has gained popularity is local infiltration with local anesthetics through the placement of an intraarticular catheter that allows for continuous local anesthetic infusion within the joint [4,7,14,17,19,22]. Recent studies have examined continuous intraarticular infusion of local anesthetic in orthopaedic surgery, concluding postoperative pain, the need for opioids as rescue medication, and mean length of hospital stay are reduced [4,8,10,14,19,21]. We undertook this study to analyze the possible benefits of continuous intraarticular infusion of ropivacaine in patients undergoing TKA.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Analgesia in TKA: Ropivacaine Continuous Intraarticular Infusion

Gómez-Cardero

Rodríguez-Merchán

2010

Clinical Orthopaedics &Amp; Related Research

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Background Postoperative pain control is a challenge in patients undergoing TKA due to side effects and technical limitations of current analgesic approaches. Local anesthetic infiltration through continuous infusion pumps has been shown to reduce postoperative pain in previous studies. Questions/purposes We assessed the effectiveness of intraarticular ropivacaine infusions in reducing pain and postoperative opioid use after TKA and determined whether such infusions accelerate functional recovery of the patient and reduce length of hospital stay. Methods In a randomized, prospective, double-blind study, two groups were assigned: Group A (n = 25) underwent continuous intraarticular infusion with 300 mL ropivacaine 0.2% at a speed of 5 mL/hour through an elastomeric infusion pump and Group B (n = 25) had an elastomeric pump insertion with 300 mL saline solution at an infusion speed of 5 mL/hour. All patients had the same prosthesis model implanted. Parameters analyzed over the first 3 days, at discharge, and 1 month later included postoperative pain, joint function, opioid use, and length of hospital stay.

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“…6,15,16 Apart from, ketorolac, morphine, ropivacaine and adrenaline, some studies have explored steroids as antiinflammatory agents. 6,17,18 Surgical trauma during TKA modifies the responsiveness of the nervous system.…”

Section: Discussionmentioning

confidence: 99%

Multimodal periarticular cocktail injection using steroid in total knee arthroplasty: a double blind randomised trial

et al. 2017

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Background: Multimodal periarticular cocktail injection (MPCI) containing local anesthetics, adrenaline, and anti-inflammatory agents such as NSAIDS have been promising in terms of quick functional recovery. This study evaluates the efficiency of steroid as a component of MPCI in knee arthroplasty.Methods: This is a prospective, double-blind, RCT where 36 patients with osteoarthritis were included and randomized to receive MPCI either with steroid or without steroid. Pain was evaluated by visual analogue scale (VAS) at preoperative and postoperatively at rest, and during activity. The range of motion of the knee was looked for in a similar way. The amount of NSAIDs and the duration of NSAID usage were noted till the last follow-up.Results: Both non-steroid and steroid groups were similar with regard to VAS at rest and during activity, or range of motion, at all postoperative observations. The postoperative knee society knee score in the steroid group improved significantly as compared to that in non-steroid group at the one-month (84.1±13.1 and 65.9±12.1; p<0.0045) and three-month follow-up (90.2±16.3 and 72.5±16.6; p<0.0027), but no significant difference was noted at six-month follow up. There was no significant difference in consumption of NSAIDs within 72 hours between the two groups. The duration of piroxicam usage in patients in the steroid group was significantly shorter than that in the non-steroid group, (7.2±0.7) compared with (10.5±1.9) weeks; =0.012.Conclusions: The Study validates usage of steroid in MPCI due to faster rehabilitation and less consumption of NSAIDs and no additional risk of post-operative complications.

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Serum and Wound Drain Ropivacaine Concentrations After Wound Infiltration in Joint Arthroplasty

Cited by 27 publications

References 24 publications

Column-switching HPLC–MS/MS analysis of ropivacaine in serum, ultrafiltrate and drainage blood for validating the safety of blood reinfusion

Column-switching HPLC–MS/MS analysis of ropivacaine in serum, ultrafiltrate and drainage blood for validating the safety of blood reinfusion

Postoperative Analgesia in TKA: Ropivacaine Continuous Intraarticular Infusion

Multimodal periarticular cocktail injection using steroid in total knee arthroplasty: a double blind randomised trial

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