Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
J Arthroplasty. 2020 Jan;35(1):76-81. doi: 10.1016/j.arth.2019.08.050. Epub 2019 Aug 29.
Local infiltration analgesia (LIA) is widely used in patients undergoing total knee arthroplasty and often contains epinephrine for a prolonged analgesic effect and to reduce systemic absorption of the local anesthetic. This retrospective observational study investigated the hemodynamic effect of locally infiltrated epinephrine after deflation of the tourniquet during total knee arthroplasty.
We reviewed the electronic medical records of patients who underwent total knee arthroplasty between January 2017 and February 2018 at a tertiary care university hospital. Total knee arthroplasty was performed using a conventional technique with a pneumatic tourniquet. LIA consisted of ropivacaine, morphine sulfate, ketorolac, and methylprednisolone. The patients were grouped according to whether or not epinephrine was included in the LIA. The incidence of a hypertensive response (systolic blood pressure >160 mmHg or mean blood pressure >110 mmHg) after deflation of the tourniquet was compared between the 2 groups.
A total of 452 patients had received LIA with (n = 188) or without (n = 264) epinephrine. A hypertensive response after deflation of the tourniquet was more common in patients who received LIA containing epinephrine (42/188 [22.3%]) than in those who received LIA without epinephrine (14/264 [5.3%], P < .001). However, the incidence of hypotension after deflation of the tourniquet was not significantly different between the 2 groups (P = .976).
Because epinephrine-containing LIA can result in a hypertensive response after deflation of the tourniquet during total knee arthroplasty, it should be cautiously administered, especially in patients with cardiovascular comorbidities.
局部浸润镇痛（LIA）广泛应用于全膝关节置换术患者，常含有肾上腺素以延长镇痛效果并减少局部麻醉药的全身吸收。本回顾性观察性研究调查了全膝关节置换术中止血带放气时局部浸润肾上腺素对血流动力学的影响。
我们回顾了 2017 年 1 月至 2018 年 2 月在一家三级护理大学医院接受全膝关节置换术的患者的电子病历。全膝关节置换术采用常规技术和气动止血带进行。LIA 由罗哌卡因、硫酸吗啡、酮咯酸和甲泼尼龙组成。根据 LIA 是否含有肾上腺素，将患者分为两组。比较两组患者止血带放气后高血压反应（收缩压>160mmHg 或平均血压>110mmHg）的发生率。
共有 452 例患者接受了含有（n=188）或不含有（n=264）肾上腺素的 LIA。含肾上腺素的 LIA 组（42/188 [22.3%]）患者止血带放气后高血压反应较常见，而不含肾上腺素的 LIA 组（14/264 [5.3%]，P<.001）。然而，两组患者止血带放气后低血压的发生率无显著差异（P=.976）。
由于含肾上腺素的 LIA 可能导致全膝关节置换术中止血带放气后高血压反应，因此应谨慎使用，特别是在有心血管合并症的患者中。
