Angerame Marc R, Hart Gavin P, Odum Susan M, Springer Bryan D
Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, NC, USA.
The Center for Bone and Joint Surgery of the Palm Beaches, Wellington, FL, USA.
Arthroplast Today. 2017 Aug 31;4(2):227-231. doi: 10.1016/j.artd.2017.07.008. eCollection 2018 Jun.
Intraoperative periarticular injection (PAI) with local anesthetic is an important component of multimodal pain control in total joint arthroplasty (TJA). A potential risk of this practice is serum anesthetic toxicity resulting from the autotransfusion of blood collected from a reinfusion drain. The purpose of this study is to evaluate the levels of bupivacaine in blood collected in an autotransfusion system after use of a PAI in TJA.
In this prospective study, each TJA patient had an identical PAI consisting of 20 cc of liposomal bupivacaine, 30 cc of 0.25% bupivacaine with epinephrine, and 10 cc of normal saline. An autologous reinfusion drain was utilized in all patients. At 2 and 5 hours postoperatively, blood was collected from the autotransfusion canister and sent to the laboratory to quantify bupivacaine levels. The sums of these levels were compared to the lowest reported serum bupivacaine dose associated with toxicity (1.1 mg/kg).
Eleven unilateral TJA patients were enrolled (6 total knee arthroplasties, 5 total hip arthroplasties). The average 2-hour serum bupivacaine level was 2.9 μg (range 0.8-5.6) while the average 5-hour serum bupivacaine level was 4.5 μg (range 0.4-10.0). The average sum of the 2-hour and 5-hour serum bupivacaine level was 5.6 μg (range 0.8-13.6). Each of the 11 patient samples were well below their minimum serum bupivacaine dose toxicity.
Use of a reinfusion drain after PAI with liposomal bupivacaine in TJA appears safe, as bupivacaine levels in the autotransfused blood remains well below the reported minimum serum toxic dose.
IV.
术中关节周围注射（PAI）局部麻醉剂是全关节置换术（TJA）多模式疼痛控制的重要组成部分。这种做法的一个潜在风险是，从再灌注引流管收集的血液进行自体输血导致血清麻醉剂毒性。本研究的目的是评估在TJA中使用PAI后，自体输血系统收集的血液中布比卡因的水平。
在这项前瞻性研究中，每位TJA患者接受相同的PAI，包括20 cc脂质体布比卡因、30 cc含肾上腺素的0.25%布比卡因和10 cc生理盐水。所有患者均使用自体再灌注引流管。术后2小时和5小时，从自体输血罐中采集血液并送至实验室，以量化布比卡因水平。将这些水平的总和与报告的与毒性相关的最低血清布比卡因剂量（1.1 mg/kg）进行比较。
纳入11例单侧TJA患者（6例全膝关节置换术，5例全髋关节置换术）。2小时时血清布比卡因平均水平为2.9 μg（范围0.8 - 5.6），而5小时时血清布比卡因平均水平为4.5 μg（范围0.4 - 10.0）。2小时和5小时血清布比卡因水平的平均总和为5.6 μg（范围0.8 - 13.6）。11例患者的每个样本均远低于其最低血清布比卡因剂量毒性。
在TJA中使用脂质体布比卡因进行PAI后使用再灌注引流管似乎是安全的，因为自体输血血液中的布比卡因水平仍远低于报告的最低血清中毒剂量。
IV级。
