Document Detail

Is peri-articular multimodal drug infiltration in knee arthroplasty safe when used in conjunction with autologous retransfusion drains?
MedLine Citation:
PMID:  20501020     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Adequate peri-operative analgesia following total knee arthroplasty (TKA) promotes earlier rehabilitation but remains problematic because of the drug side-effects. Peri-articular multimodal drug infiltration (PMDI) has been developed as an alternative strategy to avoid such complications. Autologous retransfusion drains reduce the need for peri-operative allogenic blood transfusions and the consequent risk. There is a theoretical risk of local anaesthesia toxicity when these systems are used concurrently. We performed a review of current practice to quantify this risk.
PATIENTS AND METHODS: A series of 10 patients undergoing TKA by the senior author (CAB) had drain fluid analysed for the concentration of ropivacaine. At the same time, the patients completed a questionnaire to establish the presence of ropivacaine-induced side-effects.
RESULTS: The ropivacaine level in the retransfusion blood was less than 10 mg in all patients. This concentration was a factor of 6 below the published safe level. Three patients had minor neurological disturbances which recovered spontaneously and quickly. There were no cases of significant cardiovascular compromise.
CONCLUSIONS: The theoretical risk of local anaesthesia toxicity when these systems are used together is negligible and we conclude that peri-articular multimodal drug infiltration is safe in conjunction with the use of autotransfusion drains.
I Gill; K Gallagher; C A Busch
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of the Royal College of Surgeons of England     Volume:  92     ISSN:  1478-7083     ISO Abbreviation:  Ann R Coll Surg Engl     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-05-26     Completed Date:  2010-06-16     Revised Date:  2011-08-01    
Medline Journal Info:
Nlm Unique ID:  7506860     Medline TA:  Ann R Coll Surg Engl     Country:  England    
Other Details:
Languages:  eng     Pagination:  335-7     Citation Subset:  IM    
Trauma and Orthopaedic Department, Ashford & St Peters NHS Trust, Ashford, UK.
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MeSH Terms
Amides / administration & dosage,  adverse effects*,  blood
Anesthetics, Local / administration & dosage,  adverse effects*,  blood
Arthroplasty, Replacement, Knee / methods*
Blood Transfusion, Autologous*
Central Nervous System Diseases / chemically induced
Dose-Response Relationship, Drug
Drainage / methods
Injections, Intra-Articular
Pain, Postoperative / prevention & control
Risk Assessment / methods
Reg. No./Substance:
0/Amides; 0/Anesthetics, Local; 84057-95-4/ropivacaine

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