Ropivacaine plasma levels following high-dose local infiltration analgesia for total knee arthroplasty

A. M. Gill, N. B. Scott, M. Abbas, D. G. Watson, K. Place, David McDonald

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

We measured total and free plasma concentrations of ropivacaine following high-volume, high-dose local infiltration analgesia in 28 patients aged 65 years or over undergoing unilateral total knee arthroplasty. Patients received infiltration of ropivacaine 400 mg followed by infusion at 20 mg.h<sup>-1</sup> through an intra-articular catheter. Total and free plasma levels of ropivacaine were measured at specified time intervals during a 24-h period after tourniquet release. Patients were monitored for symptoms and signs of local anaesthetic toxicity. Total levels of plasma ropivacaine varied from 0.147 to 3.093 μg.ml<sup>-1</sup> (mean (SD) 1.105 (0.518) μg.ml<sup>-1</sup>). Free levels of plasma ropivaca-ine varied from 0.001 to 0.104 μg.ml<sup>-1</sup> (mean (SD) 0.037 (0.020) μg.ml<sup>-1</sup>). Six samples had total plasma ropivacaine levels greater the toxic threshold of 2.2 μg.ml<sup>-1</sup>. No samples reached the toxic threshold for free venous ropivacaine concentration. We conclude that the use of high-dose ropivacaine infiltration and catheter infusion for total knee arthroplasty in an elderly population does not result in free plasma ropivacaine levels previously associated with toxicity but that raised total plasma levels may be observed.

LanguageEnglish
Pages784-790
Number of pages7
JournalAnaesthesia
Volume70
Issue number7
Early online date22 Feb 2015
DOIs
Publication statusPublished - 1 Jul 2015

Fingerprint

Knee Replacement Arthroplasties
Analgesia
Poisons
Catheters
Tourniquets
ropivacaine
Local Anesthetics
Signs and Symptoms
Joints

Keywords

  • ropivacaine
  • local infiltration analgesia
  • local anaesthetic toxicity
  • free plasma ropivacaine

Cite this

Gill, A. M. ; Scott, N. B. ; Abbas, M. ; Watson, D. G. ; Place, K. ; McDonald, David. / Ropivacaine plasma levels following high-dose local infiltration analgesia for total knee arthroplasty. In: Anaesthesia. 2015 ; Vol. 70, No. 7. pp. 784-790.
@article{7f7c02e7401d41248e6cd31383eff507,
title = "Ropivacaine plasma levels following high-dose local infiltration analgesia for total knee arthroplasty",
abstract = "We measured total and free plasma concentrations of ropivacaine following high-volume, high-dose local infiltration analgesia in 28 patients aged 65 years or over undergoing unilateral total knee arthroplasty. Patients received infiltration of ropivacaine 400 mg followed by infusion at 20 mg.h-1 through an intra-articular catheter. Total and free plasma levels of ropivacaine were measured at specified time intervals during a 24-h period after tourniquet release. Patients were monitored for symptoms and signs of local anaesthetic toxicity. Total levels of plasma ropivacaine varied from 0.147 to 3.093 μg.ml-1 (mean (SD) 1.105 (0.518) μg.ml-1). Free levels of plasma ropivaca-ine varied from 0.001 to 0.104 μg.ml-1 (mean (SD) 0.037 (0.020) μg.ml-1). Six samples had total plasma ropivacaine levels greater the toxic threshold of 2.2 μg.ml-1. No samples reached the toxic threshold for free venous ropivacaine concentration. We conclude that the use of high-dose ropivacaine infiltration and catheter infusion for total knee arthroplasty in an elderly population does not result in free plasma ropivacaine levels previously associated with toxicity but that raised total plasma levels may be observed.",
keywords = "ropivacaine, local infiltration analgesia, local anaesthetic toxicity, free plasma ropivacaine",
author = "Gill, {A. M.} and Scott, {N. B.} and M. Abbas and Watson, {D. G.} and K. Place and David McDonald",
note = "This is the peer reviewed version of the following article: Gill, A. M., Scott, N. B., Abbas, M., Watson, D. G., Place, K., & McDonald, D. A. (2015). Ropivacaine plasma levels following high-dose local infiltration analgesia for total knee arthroplasty. Anaesthesia, 70(7), 784-790., which has been published in final form at http://dx.doi.org/10.1111/anae.13017. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.",
year = "2015",
month = "7",
day = "1",
doi = "10.1111/anae.13017",
language = "English",
volume = "70",
pages = "784--790",
journal = "Anaesthesia",
issn = "0003-2409",
number = "7",

}

Ropivacaine plasma levels following high-dose local infiltration analgesia for total knee arthroplasty. / Gill, A. M.; Scott, N. B.; Abbas, M.; Watson, D. G.; Place, K.; McDonald, David.

In: Anaesthesia, Vol. 70, No. 7, 01.07.2015, p. 784-790.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Ropivacaine plasma levels following high-dose local infiltration analgesia for total knee arthroplasty

AU - Gill, A. M.

AU - Scott, N. B.

AU - Abbas, M.

AU - Watson, D. G.

AU - Place, K.

AU - McDonald, David

N1 - This is the peer reviewed version of the following article: Gill, A. M., Scott, N. B., Abbas, M., Watson, D. G., Place, K., & McDonald, D. A. (2015). Ropivacaine plasma levels following high-dose local infiltration analgesia for total knee arthroplasty. Anaesthesia, 70(7), 784-790., which has been published in final form at http://dx.doi.org/10.1111/anae.13017. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.

PY - 2015/7/1

Y1 - 2015/7/1

N2 - We measured total and free plasma concentrations of ropivacaine following high-volume, high-dose local infiltration analgesia in 28 patients aged 65 years or over undergoing unilateral total knee arthroplasty. Patients received infiltration of ropivacaine 400 mg followed by infusion at 20 mg.h-1 through an intra-articular catheter. Total and free plasma levels of ropivacaine were measured at specified time intervals during a 24-h period after tourniquet release. Patients were monitored for symptoms and signs of local anaesthetic toxicity. Total levels of plasma ropivacaine varied from 0.147 to 3.093 μg.ml-1 (mean (SD) 1.105 (0.518) μg.ml-1). Free levels of plasma ropivaca-ine varied from 0.001 to 0.104 μg.ml-1 (mean (SD) 0.037 (0.020) μg.ml-1). Six samples had total plasma ropivacaine levels greater the toxic threshold of 2.2 μg.ml-1. No samples reached the toxic threshold for free venous ropivacaine concentration. We conclude that the use of high-dose ropivacaine infiltration and catheter infusion for total knee arthroplasty in an elderly population does not result in free plasma ropivacaine levels previously associated with toxicity but that raised total plasma levels may be observed.

AB - We measured total and free plasma concentrations of ropivacaine following high-volume, high-dose local infiltration analgesia in 28 patients aged 65 years or over undergoing unilateral total knee arthroplasty. Patients received infiltration of ropivacaine 400 mg followed by infusion at 20 mg.h-1 through an intra-articular catheter. Total and free plasma levels of ropivacaine were measured at specified time intervals during a 24-h period after tourniquet release. Patients were monitored for symptoms and signs of local anaesthetic toxicity. Total levels of plasma ropivacaine varied from 0.147 to 3.093 μg.ml-1 (mean (SD) 1.105 (0.518) μg.ml-1). Free levels of plasma ropivaca-ine varied from 0.001 to 0.104 μg.ml-1 (mean (SD) 0.037 (0.020) μg.ml-1). Six samples had total plasma ropivacaine levels greater the toxic threshold of 2.2 μg.ml-1. No samples reached the toxic threshold for free venous ropivacaine concentration. We conclude that the use of high-dose ropivacaine infiltration and catheter infusion for total knee arthroplasty in an elderly population does not result in free plasma ropivacaine levels previously associated with toxicity but that raised total plasma levels may be observed.

KW - ropivacaine

KW - local infiltration analgesia

KW - local anaesthetic toxicity

KW - free plasma ropivacaine

UR - http://www.scopus.com/inward/record.url?scp=84930865693&partnerID=8YFLogxK

U2 - 10.1111/anae.13017

DO - 10.1111/anae.13017

M3 - Article

VL - 70

SP - 784

EP - 790

JO - Anaesthesia

T2 - Anaesthesia

JF - Anaesthesia

SN - 0003-2409

IS - 7

ER -