title: The safety of peri-articular local anaesthetic injection for patients undergoing total knee replacement with autologous blood transfusion: a randomised trial.
abstract: 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.
authors.affiliation: University Hospitals Coventry and Warwickshire NHS Trust, University Hospital, Clifford Bridge Road, Coventry CV2 2DX, UK.
authors.forename: D F
authors.initials: DF
authors.lastname: Wallace
authors.forename: S R
authors.initials: SR
authors.lastname: Emmett
authors.forename: K K
authors.initials: KK
authors.lastname: Kang
authors.forename: G S
authors.initials: GS
authors.lastname: Chahal
authors.forename: R
authors.initials: R
authors.lastname: Hiskens
authors.forename: S
authors.initials: S
authors.lastname: Balasubramanian
authors.forename: K
authors.initials: K
authors.lastname: McGuinness
authors.forename: H
authors.initials: H
authors.lastname: Parsons
authors.forename: J
authors.initials: J
authors.lastname: Achten
authors.forename: M L
authors.initials: ML
authors.lastname: Costa
mesh_terms: D000368:Aged; D000772:Anesthesia, Local / Q000009:adverse effects / Q000379:methods*; D000779:Anesthetics, Local / Q000097:blood* / Q000627:therapeutic use; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D001804:Blood Transfusion, Autologous / Q000379:methods*; D003131:Combined Modality Therapy; D004322:Drainage / Q000379:methods*; D005260:Female; D005267:Femoral Nerve; D006801:Humans; D007270:Injections, Intra-Articular; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local