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Intra-operative, peri-articular injection of local anaesthesia is an increasingly popular way of controlling pain following total knee replacement. At the same time, the problems associated with allogenic blood transfusion have led to interest in alternative methods for managing blood loss after total knee replacement, including the use of auto-transfusion of fluid from the patient's surgical drain. It is safe to combine peri-articular infiltration with auto-transfusion from the drain. We performed a randomised clinical trial to compare the concentration of local anaesthetic in the blood and in the fluid collected in the knee drain in patients having either a peri-articular injection or a femoral nerve block. Clinically relevant concentrations of local anaesthetic were found in the fluid from the drains of patients having peri-articular injections (4.92 μg/ml (sd 3.151)). However, none of the patients having femoral nerve blockade had detectable levels. None of the patients in either group had clinically relevant concentrations of local anaesthetic in their blood after re-transfusion. The evidence from this study suggests that it is safe to use peri-articular injection in combination with auto-transfusion of blood from peri-articular drains during knee replacement surgery.

Original publication

DOI

10.1302/0301-620X.94B12.29357

Type

Journal article

Journal

J Bone Joint Surg Br

Publication Date

12/2012

Volume

94

Pages

1632 - 1636

Keywords

Aged, Anesthesia, Local, Anesthetics, Local, Arthroplasty, Replacement, Knee, Blood Transfusion, Autologous, Combined Modality Therapy, Drainage, Female, Femoral Nerve, Humans, Injections, Intra-Articular, Knee Joint, Male, Middle Aged, Nerve Block, Treatment Outcome