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Article: An Observational Study of the Pharmacokinetics of Adductor Canal Block using Liposomal Bupivacaine and Standard Bupivacaine in Total Knee Arthroplasty

TitleAn Observational Study of the Pharmacokinetics of Adductor Canal Block using Liposomal Bupivacaine and Standard Bupivacaine in Total Knee Arthroplasty
Authors
Issue Date15-Feb-2023
PublisherFrontiers Media
Citation
Journal of Pharmacy and Pharmaceutical Sciences, 2023 How to Cite?
Abstract

Background

Periarticular local infiltration of analgesia (LIA) and regional nerve block using adductor canal block (ACB) have been effective in managing postoperative pain for total knee arthroplasty (TKA). It has been shown that combining ACB with LIA can significantly reduce pain scores and morphine consumption compared with LIA alone. However, this raises concerns about the potential risk of local anesthetic systemic toxicity (LAST), especially with the large doses of total local anesthetic used in both LIA and ACB.

This study was to evaluate the plasma level of bupivacaine over a 72-hour period following ACB using 66.5 mg of liposomal bupivacaine (LB) in patients undergoing TKA with LIA using 300 mg ropivacaine.

Methods

This was a prospective observational study. Ten patients undergoing primary, unilateral, simple revision TKA in a tertiary hospital in Hong Kong between December 2020 to February 2022 were included in the study.

The primary outcomes were the time to peak plasma concentration (Tmax) of bupivacaine and the peak plasma concentration (Cmax) of bupivacaine. The secondary outcome was the presence of LAST.

Results

Tmax of bupivacaine was 48 hours while Cmax of bupivacaine was 88 mcg/L, this value was far below 2000 mcg/L, the defined toxic plasma concentration of bupivacaine.

Conclusions

There is still room for increasing the dose of LB used in ACB for TKA patients, further dose-defining studies with PK data are needed to define the optimal dose that would balance the safety and efficacy of LB.


Persistent Identifierhttp://hdl.handle.net/10722/338222
ISSN
2023 Impact Factor: 2.9
2023 SCImago Journal Rankings: 0.619

 

DC FieldValueLanguage
dc.contributor.authorChan, Will Shing Him-
dc.contributor.authorChan, Timmy Chi Wing-
dc.contributor.authorMak, Henry Chi Yeung-
dc.contributor.authorChan, Manson Tak Hei-
dc.contributor.authorCheung, Clement Hoo Chun-
dc.contributor.authorLeung, Susan Wai Sum-
dc.contributor.authorLi, Steve Po Yam-
dc.contributor.authorWong, Stanley Sau Ching-
dc.contributor.authorCheung, Chi Wai-
dc.date.accessioned2024-03-11T10:27:11Z-
dc.date.available2024-03-11T10:27:11Z-
dc.date.issued2023-02-15-
dc.identifier.citationJournal of Pharmacy and Pharmaceutical Sciences, 2023-
dc.identifier.issn1482-1826-
dc.identifier.urihttp://hdl.handle.net/10722/338222-
dc.description.abstract<p><strong>Background</strong></p><p>Periarticular local infiltration of analgesia (LIA) and regional nerve block using adductor canal block (ACB) have been effective in managing postoperative pain for total knee arthroplasty (TKA). It has been shown that combining ACB with LIA can significantly reduce pain scores and morphine consumption compared with LIA alone. However, this raises concerns about the potential risk of local anesthetic systemic toxicity (LAST), especially with the large doses of total local anesthetic used in both LIA and ACB.</p><p>This study was to evaluate the plasma level of bupivacaine over a 72-hour period following ACB using 66.5 mg of liposomal bupivacaine (LB) in patients undergoing TKA with LIA using 300 mg ropivacaine.</p><p><strong>Methods</strong></p><p>This was a prospective observational study. Ten patients undergoing primary, unilateral, simple revision TKA in a tertiary hospital in Hong Kong between December 2020 to February 2022 were included in the study.</p><p>The primary outcomes were the time to peak plasma concentration (Tmax) of bupivacaine and the peak plasma concentration (Cmax) of bupivacaine. The secondary outcome was the presence of LAST.</p><p><strong>Results</strong></p><p>Tmax of bupivacaine was 48 hours while Cmax of bupivacaine was 88 mcg/L, this value was far below 2000 mcg/L, the defined toxic plasma concentration of bupivacaine.</p><p><strong>Conclusions</strong></p><p>There is still room for increasing the dose of LB used in ACB for TKA patients, further dose-defining studies with PK data are needed to define the optimal dose that would balance the safety and efficacy of LB.</p>-
dc.languageeng-
dc.publisherFrontiers Media-
dc.relation.ispartofJournal of Pharmacy and Pharmaceutical Sciences-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.titleAn Observational Study of the Pharmacokinetics of Adductor Canal Block using Liposomal Bupivacaine and Standard Bupivacaine in Total Knee Arthroplasty-
dc.typeArticle-
dc.identifier.doi10.21203/rs.3.rs-2545922/v1-
dc.identifier.eissn1482-1826-
dc.identifier.issnl1482-1826-

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