Klasan Antonio, Rigaud Marcel, Hammer Sascha, Kammerlander Christian, Schittek Gregor
AUVA UKH Graz, Graz, Austria.
Johannes Kepler University of Linz, Linz, Austria.
Arch Orthop Trauma Surg. 2025 Jan 3;145(1):108. doi: 10.1007/s00402-024-05719-2.
The role of local infiltration anesthesia (LIA) in knee surgery is significant. LIA can be more potent than a nerve block, but without the downsides. A wide range of agents are used for LIA, including some off-label medications such as dexmedetomidine and ropivacaine. Dexmedetomidine has recently received attention for decreasing demand for anesthetic agents and prolonged effect of anesthesia. The purpose of this study was to demonstrate safety of dexmedetomidine and ropivacaine as LIA.
This is a retrospective analysis of 200 patients receiving 300 mg of ropivacaine, 100 µg of dexmedetomidine and 10 mL of saline solution as LIA. Both agents are off-label for this use. The LIA applied prior to skin closure as a pertiarticular block. Major knee surgery was defined as ligament reconstruction of at least one ligament, fracture of the femur and the tibia, knee replacement and osteotomy. We evaluated short-term major side-effects of these agents, and evaluated 30-day complications.
Included were 77 arthroplasties, 10 fracture fixations, 19 osteotomies, 55 primary and revision ACL, 10 isolated medial patellar femoral ligament reconstructions, 2 ACLs combined with a partial knee arthroplasty, 4 cartilage transplantations and 23 multiligament knee reconstructions. We observed one transitory discoloration after an ACL reconstruction that disappeared by the 48 h mark. We had no 30-day superficial or deep infections. Cardiac or allergic reactions were not observed.
LIA in a combination of single high-dose ropivacaine and dexmedetomidine is safe in knee surgery. Further studies evaluating pain relief with this LIA combination are needed.
局部浸润麻醉（LIA）在膝关节手术中作用显著。LIA可能比神经阻滞更有效，且无其缺点。多种药物用于LIA，包括一些未标明适应证的药物，如右美托咪定和罗哌卡因。右美托咪定最近因可减少麻醉药物需求及延长麻醉效果而受到关注。本研究旨在证明右美托咪定和罗哌卡因作为LIA的安全性。
这是一项对200例接受300mg罗哌卡因、100μg右美托咪定和10mL生理盐水作为LIA患者的回顾性分析。这两种药物均为未标明适应证用药。LIA在皮肤缝合前作为关节周围阻滞应用。主要膝关节手术定义为至少一条韧带的韧带重建、股骨和胫骨骨折、膝关节置换和截骨术。我们评估了这些药物的短期主要副作用，并评估了30天并发症。
纳入77例关节置换术、10例骨折固定术、19例截骨术、55例初次和翻修前交叉韧带（ACL）手术、10例孤立的内侧髌股韧带重建术、2例ACL联合部分膝关节置换术、4例软骨移植术和23例多韧带膝关节重建术。我们观察到1例ACL重建术后出现短暂变色，在48小时时消失。未发生30天浅表或深部感染。未观察到心脏或过敏反应。
单次高剂量罗哌卡因和右美托咪定联合LIA在膝关节手术中是安全的。需要进一步研究评估这种LIA联合用药的镇痛效果。
