PDF(Pubmed)
Abstract：
BACKGROUND: Local infiltration analgesia (LIA) is frequently administered to patient undergoing joint replacement surgical procedures. The aim of the present research was to verify the safety of collected shed blood to be reinfused postoperatively, by measuring levobupivacaine levels in drainage blood in patients undergoing LIA during knee replacement surgery.
METHODS: 24 patients who underwent total knee arthroplasty (TKA) and 12 scheduled for total hip arthroplasty (THA) who received intraoperative LIA were considered. Blood samples were collected from shed blood which was present in drainage 2 and 5 hours after surgery and serum was analysed by liquid chromatography-tandem mass spectrometry.
RESULTS: At 2 hours postoperatively, the median levobupivacaine serum concentration in the collected shed blood was 1.2 mg/L (SD: 4.2) for TKA and 17.13 mg/L (SD: 24.4) for THA. At 5 hours, levobupivacaine concentration was 1.84 mg/L (SD: 2.2) for TKA and 17.5 mg/L (SD: 25.2) for THA. Higher values of average serum levobupivacaine concentration were reported in drains collected from patients who had undergone THA compared to TKA (p<0.001). BMI significantly influenced levels of serum drug, that resulted to be higher in patients with BMI<25 (p= 0.01).
CONCLUSIONS: Levobupivacaine from collected shed blood that would have been returned to the patient, was below toxicity level at 2 and 5 hours after LIA during total joint replacement. The average serum levobupivacaine concentration was found to be higher in drains taken from THA patients than TKA patients. Patients with lower BMI demonstrated the highest levels of levobupivacaine in shed blood and a lower blood volume needed for central nervous system toxicity. Therefore, in patients with a lower BMI undergoing THA, anaesthetic dosage should be reduced or autotransfusion should be avoided to prevent potential risks of toxicity.
METHODS: 24 patients who underwent total knee arthroplasty (TKA) and 12 scheduled for total hip arthroplasty (THA) who received intraoperative LIA were considered. Blood samples were collected from shed blood which was present in drainage 2 and 5 hours after surgery and serum was analysed by liquid chromatography-tandem mass spectrometry.
RESULTS: At 2 hours postoperatively, the median levobupivacaine serum concentration in the collected shed blood was 1.2 mg/L (SD: 4.2) for TKA and 17.13 mg/L (SD: 24.4) for THA. At 5 hours, levobupivacaine concentration was 1.84 mg/L (SD: 2.2) for TKA and 17.5 mg/L (SD: 25.2) for THA. Higher values of average serum levobupivacaine concentration were reported in drains collected from patients who had undergone THA compared to TKA (p<0.001). BMI significantly influenced levels of serum drug, that resulted to be higher in patients with BMI<25 (p= 0.01).
CONCLUSIONS: Levobupivacaine from collected shed blood that would have been returned to the patient, was below toxicity level at 2 and 5 hours after LIA during total joint replacement. The average serum levobupivacaine concentration was found to be higher in drains taken from THA patients than TKA patients. Patients with lower BMI demonstrated the highest levels of levobupivacaine in shed blood and a lower blood volume needed for central nervous system toxicity. Therefore, in patients with a lower BMI undergoing THA, anaesthetic dosage should be reduced or autotransfusion should be avoided to prevent potential risks of toxicity.
摘要：
背景:局部浸润镇痛(LIA)经常被给予经历关节置换外科手术的患者。本研究的目的是验证收集的血液在术后重新输注的安全性，通过测量膝关节置换手术期间接受LIA的患者的引流血液中的左旋布比卡因水平。
方法：考虑24例接受全膝关节置换术（TKA）的患者和12例接受术中LIA的计划行全髋关节置换术（THA）的患者。从手术后2和5小时存在于引流中的流出血液中收集血液样品，并通过液相色谱-串联质谱法分析血清。
结果：术后2小时，TKA和THA采集的血中左旋布比卡因血清浓度中位数分别为1.2mg/L(SD:4.2)和17.13mg/L(SD:24.4).5小时后,左布比卡因浓度TKA为1.84mg/L（SD：2.2），THA为17.5mg/L（SD：25.2）。与TKA相比，THA患者的平均血清左布比卡因浓度更高（p<0.001）。BMI显著影响血清药物水平，这导致BMI<25的患者更高（p=0.01）。
结论：从收集的血液中提取的左旋布比卡因，在全关节置换期间，LIA后2小时和5小时低于毒性水平。发现THA患者的平均血清左布比卡因浓度高于TKA患者。BMI较低的患者在流出的血液中显示出最高水平的左布比卡因，并且中枢神经系统毒性所需的血容量较低。因此,在接受THA的BMI较低的患者中，应减少麻醉剂量或避免自体输血，以防止潜在的毒性风险。
方法：考虑24例接受全膝关节置换术（TKA）的患者和12例接受术中LIA的计划行全髋关节置换术（THA）的患者。从手术后2和5小时存在于引流中的流出血液中收集血液样品，并通过液相色谱-串联质谱法分析血清。
结果：术后2小时，TKA和THA采集的血中左旋布比卡因血清浓度中位数分别为1.2mg/L(SD:4.2)和17.13mg/L(SD:24.4).5小时后,左布比卡因浓度TKA为1.84mg/L（SD：2.2），THA为17.5mg/L（SD：25.2）。与TKA相比，THA患者的平均血清左布比卡因浓度更高（p<0.001）。BMI显著影响血清药物水平，这导致BMI<25的患者更高（p=0.01）。
结论：从收集的血液中提取的左旋布比卡因，在全关节置换期间，LIA后2小时和5小时低于毒性水平。发现THA患者的平均血清左布比卡因浓度高于TKA患者。BMI较低的患者在流出的血液中显示出最高水平的左布比卡因，并且中枢神经系统毒性所需的血容量较低。因此,在接受THA的BMI较低的患者中，应减少麻醉剂量或避免自体输血，以防止潜在的毒性风险。
