Year 2015 Vol. 23 No 4




FSBE "P.P. Vreden Russian Research Institute of Traumatology and Orthopedics", Saint-Petersburg 1,
FSBE "Federal Center of Traumatology, Orthopedics and Joint Replacement" of the Ministry of Health of Russia, Smolensk2,
The Russian Federation

Objectives. Evaluation of the local infiltration anesthesia safety in primary total knee joint arthroplasty.
Methods. The level of total and free plasma concentrations of ropivacaine following the local infiltration anesthesia in 26 patients aged 66,29,7 years undergoing total knee arthroplasty has been studied. Patients were subjected to knee tissue infiltration with 150 mg of 0,2% ropivacaine solution followed by intraarticular anesthetic infusion at a rate of 6-8 mL/h. Total and free plasma concentration of ropivacaine was measured at 30-min, and then 4-6 hours, and 24 hours intervals after the infusion onset.
Results. After 30 min the level of plasma total ropivacaine made up 0.6960,2 μg/ml, after 4-6 h 1,580,1 μg/ml and after 24 h. 1,0390,04 μg/ml. After 30 min the level of plasma free ropivacaine was 0,0490,02 μg/ml, after 4-6 h 0,0650,02 μg/ml, and after 24 h 0,0790,012 μg/ml. 4 hours after the intra-articular infusion of ropivacaine onset, transient dizziness, nausea and disturbance of vision were registered in two patients but they did not require any special treatment. It appears that at this moment total levels of plasma ropivacaine varied from 1,789 and 1,805 μg/ml, level of the free ropivacaine 0,078 μg/ml and 0,095 μg/ml, respectively. No specific therapy is required. An increase in total plasma ropivacaine concentrations in 4-6 hours after the infusion onset was caused by the reduction of the level of alpha-1-acid glycoprotein associated with the conducted infusion therapy and hemodilution.
Conclusion. The application of high-dose ropivacaine for the local infiltration anesthesia with further intra-articular infusion of the local anesthetic for pain relief is considered to be as a sufficiently safe method: the level of free plasma concentrations of ropivacaine does not reach statistical significance associated with clinical manifestations of local anesthetic toxicity.

Keywords: local infiltration analgesia, local anesthetics, concentration of free ropivacaine, concentration of ropivacaine in blood, toxicity of local anesthetics, total knee joint arthroplasty
p. 436-339 of the original issue
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Address for correspondence:
195427, g. Saint-Petersburg,
ul. Akademika Baykova, d. 8,
FGBU "RNIITO imeni P.P. Vredena"
Minzdrava Rossii, ,
nauchnoe otdelenie diagnostiki zabolevaniy
i povrezhdeniy oporno-dvigatelnoy sistemyi,
tel.: 79052111429,
Koryachkin Viktor Anatolevich
Information about the authors:
Koryachkin V.A. MD, professor, a head of the research department of diagnostics of diseases and traumas of the musculoskeletal system of FSBE "P.P. Vreden Russian Research Institute of Traumatology and Orthopedics", Saint-Petersburg.
Geraskov E.V. An anesthetist-reanimatologist of the department of anesthesiology and resuscitation of FSBE "Federal Center of Traumatology, Orthopedics and Joint Replacement" of the Ministry of Health of Russia, Smolensk
Korshunov D.Y. A head of the traumatology and orthopedics department 1 of FSBE "Federal Center of Traumatology, Orthopedics and Joint Replacement" of the Ministry of Health of Russia, Smolensk
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