Thomassen Bregje J W, Pool Laurens, Van Der Flier Rudolf, Stienstra Rudolf, in 't Veld Bastiaan A
Department of Orthopaedic Surgery, Medical Center Haaglanden, The Hague, The Netherlands.
Acta Orthop Belg. 2012 Aug;78(4):506-11.
We investigated the safety of LIA (local infiltration analgesia) combined with retransfusion of drained blood. Total knee arthroplasty patients received two peri-articular injections during surgery followed by continuous infusion, both with ropivacaine (567 mg). Ropivacaine plasma concentrations were determined in blood samples taken at 0, 3, 6 and 24 hours postoperatively. The collected shed blood was not retransfused, instead retransfusion was modelled by estimating the cumulative plasma concentrations at 6 hours postoperative. Total and unbound ropivacaine plasma concentrations ranged respectively from 0.08 to 1.9 mg/L and 0.003 to 0.11 mg/L. An average of 13.1 +/- 3.7 mg unbound ropivacaine would have been returned to the patient. The estimated cumulative ropivacaine plasma levels showed that instant retransfusion would have led to plasma levels below 0.26 mg/L. It appears to be safe to transfuse autologous blood in combination with LIA. However, before drawing definite conclusions formal measurement of actual concentrations is required.
我们研究了局部浸润麻醉（LIA）联合引流血回输的安全性。全膝关节置换术患者在手术期间接受了两次关节周围注射，随后持续输注，均使用罗哌卡因（567毫克）。在术后0、3、6和24小时采集的血样中测定罗哌卡因血浆浓度。所收集的引流血未进行回输，而是通过估计术后6小时的累积血浆浓度来模拟回输情况。罗哌卡因总血浆浓度和游离血浆浓度分别为0.08至1.9毫克/升和0.003至0.11毫克/升。平均有13.1±3.7毫克游离罗哌卡因会回输给患者。估计的罗哌卡因累积血浆水平表明，即刻回输会导致血浆水平低于0.26毫克/升。LIA联合自体血回输似乎是安全的。然而，在得出明确结论之前，需要对实际浓度进行正式测定。
