N°268 - Book 1 - November 2017
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How I perform surgical site infiltration with local anaesthetics
By Y. Michaud, D. Jochum in category
Hôpital Schweitzer - Colmar / [email protected]
Operative site infiltration with local anaesthetics is developing along with rapid recovery procedures and prostheses in outpatient surgery. In our experience, it is a simple and low-risk technique that can relieve or even often eliminate pain on waking and during the first few hours after surgery. As a result, rehabilitation is easier and it becomes possible for the patients to walk as soon as they leave the post-anaesthesia care unit.
We recently modified our procedure by performing infiltration at the beginning of and during the procedure. Here, we present our infiltration technique for total hip and knee arthroplasties (THAs and TKAs).
We infiltrate the surgical site with 120–150 ml of a mixture of 200 ml ropivacaine at 2 mg/ml + 1 ampoule of adrenaline at 1 mg/ml.
The mixture is prepared by the theatre nurse at the beginning of the procedure. It is unfortunate that there is no ready-to-use mixture, which would limit handling and reduce the risk of aseptic preparation.
Ropivacaine has the advantage of having a less marked vasodilator effect than bupivacaine, allowing it to remain at the site of injection for longer, resulting in slower blood resorption.
We always aspirate before injecting to avoid intravascular delivery.
We use an 8-cm long, 18G...
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