title: Incidence of cardiovascular complications in knee arthroplasty patients before and after implementation of a ropivacaine local infiltration analgesia protocol: A retrospective study.
abstract: BACKGROUND
  Local infiltration analgesia (LIA) during total knee arthroplasty has been shown to give statistically significant reduction in post-operative pain. The effects of using high volumes of ropivacaine combined with adrenaline as LIA on cardiovascular parameters in knee replacement have not been described before. The objective of this study was to investigate the cardiovascular safety of ropivacaine as part of high volume local infiltration analgesia (LIA) in total knee replacement surgery.
  
  
  METHODS
  This is a retrospective observational comparative cohort study conducted in two independent cohorts, one treated without and one treated with a local infiltration analgesia protocol, containing a total of 744 patients with a mean age of 68years (42 to 89) and 68years (21 to 88) respectively with a follow-up of 12months.
  
  
  RESULTS
  No statistical difference in bradycardia during surgery, post-operative cardiovascular complications, and mortality was found after use of LIA. A statistically significant lower incidence of hypotension was found in the LIA group (P<0.01). This result has to be interpreted with care, due to the use of adrenaline in the LIA mixture, which could mask possible hypotension. No statistical difference was found in the occurrence of hypertension or tachycardia, despite the addition of adrenaline to the LIA mixture. No difference in mortality was found between the two groups (P=0.11).
  
  
  CONCLUSIONS
  These results show safe use of high volume ropivacaine with adrenaline as local infiltration analgesia during total knee replacement surgery.
authors.affiliation: Rijnland Hospital, Leiderdorp, The Netherlands. Electronic address: joostlameijer@gmail.com.
authors.forename: Joost R C
authors.initials: JR
authors.lastname: Lameijer
authors.affiliation: Rijnland Hospital, Leiderdorp, The Netherlands.
authors.forename: Frederik
authors.initials: F
authors.lastname: Verboom
authors.affiliation: Rijnland Hospital, Leiderdorp, The Netherlands.
authors.forename: Joost
authors.initials: J
authors.lastname: Grefkens
authors.affiliation: Rijnland Hospital, Leiderdorp, The Netherlands.
authors.forename: Joris
authors.initials: J
authors.lastname: Jansen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000577:Amides / Q000008:administration & dosage* / Q000009:adverse effects; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000379:methods; D002318:Cardiovascular Diseases / Q000209:etiology*; D015331:Cohort Studies; D004837:Epinephrine / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000517:prevention & control*; D012189:Retrospective Studies; D000077212:Ropivacaine; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000009:adverse effects; D055815:Young Adult
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D000077212:Ropivacaine; D004837:Epinephrine
keywords: Cardiovascular; Local anesthetic; Prosthesis; Replacement; Ropivacaine