目的:描述当关节周围注射(PAI)和周围神经阻滞(PNB)用于膝关节置换术镇痛时,局部麻醉药的剂量,并将局部剂量与建议的最大剂量进行比较,并寻找局部麻醉全身毒性的证据(LAST)。
方法:2018年5月至2022年11月的单中心回顾性队列研究。
方法:一家大型学术医院。
方法:同时患有PAI和PNB的患者,修订版,total,局部,单边,或双侧膝关节置换术。
方法:无。
方法:计算通过PAI给予局部麻醉药的剂量,PNB,和两种途径相结合,基于瘦体重,并将其与建议的最大剂量进行比较。寻找药物,临床干预措施,和提示最后事件的关键事件注释。
结果:在研究期间,有4527例膝关节置换术同时进行了PAI和PNB。当结合PAI和PNB剂量时,>75%的患者接受超过建议的最大剂量3mg/kg瘦体重。研究期间局部麻醉药给药的中位数,4.4mg/kg(IQR3.5,5.9),是建议最大剂量的147%(IQR117,197)。在研究中的任何患者中都没有LAST的确凿证据。
结论:在我们的研究过程中,我们进行了4,527次膝关节置换术,中位PAI和PNB局部麻醉剂量为建议最大剂量的147%,没有任何明确的LAST事件的临床证据.
OBJECTIVE: Describe dosing of local anesthetic when both a periarticular injection (PAI) and peripheral nerve block (PNB) are utilized for knee arthroplasty analgesia, and compare the dosing of local to suggested maximum dosing, and look for evidence of local anesthetic systemic toxicity (LAST).
METHODS: A single center retrospective cohort study between May 2018 and November 2022.
METHODS: A major academic hospital.
METHODS: Patients who had both a PAI and PNB while undergoing primary, revision, total, partial, unilateral, or bilateral knee arthroplasty.
METHODS: None.
METHODS: Calculate the dose of local anesthetic given via PAI, PNB, and both routes combined as based on lean body weight and compare that to the suggested maximum dosing. Look for medications, clinical interventions, and critical event notes suggestive of a LAST event.
RESULTS: There were 4527 knee arthroplasties where both a PAI and PNB were performed during the study period. When combining PAI and PNB doses, >75% of patients received more than the suggested maximum dose of 3 mg/kg lean body weight. The median local anesthetic dosing over the study period, 4.4 mg/kg (IQR 3.5,5.9), was 147% of the suggested maximum dose (IQR 117,197). There was no conclusive evidence of LAST among any of the patients in the study.
CONCLUSIONS: Over the course of our study, we had 4527 knee arthroplasties with a median PAI and PNB local anesthetic dose that was 147% of the suggested maximum without any clear clinical evidence of a LAST event.