Increase in early wound leakage in total knee arthroplasty with local infiltrative analgesia (LIA) that includes epinephrine: a retrospective cohort study

Authors

  • Babette C Van Der Zwaard Department of Orthopedics, Jeroen Bosch Hospital, ’s Hertogenbosch, The Netherlands
  • Ramon L Roerdink Department of Orthopedics, Jeroen Bosch Hospital, ’s Hertogenbosch, The Netherlands
  • Ruud P Van Hove Department of Orthopedics, Jeroen Bosch Hospital, ’s Hertogenbosch, The Netherlands

DOI:

https://doi.org/10.1080/17453674.2020.1815975

Abstract

Background and purpose — After introducing a new local infiltration anesthesia (LIA) protocol with addition of 30 mL ropivacaine 2% and 1 mg epinephrine, we noted an increase in early wound leakage. As wound leakage is asso- ciated with prosthetic joint infection, our department aims to minimize postoperative wound leakage. This study evalu- ates the incidence of early wound leakage and postoperative pain after knee arthroplasty (KA) following adjustment of the LIA protocol with addition of 30 cc ropivacaine 2% and 1 mg epinephrine.

Patients and methods — In this retrospective medical dossier study all patients (n = 502) undergoing a primary total or unicondylar knee arthroplasty between January 1, 2018 and July 1, 2019 were included. Patients received an LIA protocol containing 120 mL 2 mg/mL ropivacaine (ROPI– group; n = 256). After October 30, patients received an LIA protocol containing 150 mL 2 mg/mL ropivacaine with 1 mg epinephrine in the first 100 mL (ROPI+ group; n = 246). The primary outcome measure was early wound leakage (< 72 hours postoperatively), defined as wound fluid leaking past the barrier of the wound dressing. Secondary outcome mea- sure, 10-point numeric rating scale (NRS) pain (< 72 hours postoperatively) was also assessed. Data was evaluated using logistic regression.

Results — The incidence of wound leakage was higher in the ROPI+ group: 24% versus 17% in the ROPI– group (p = 0.06). After adjusting for the differences between sur- geons the relative risk of this increase was 1.4 (1.0–2.0). The ROPI+ and ROPI– group were similar regarding postopera- tive pain assessment.

Interpretation — Adjustment of the LIA protocol with 30 mL 2% ropivacaine and 1 mg epinephrine led to an increase in early wound leakage in knee arthroplasty but no difference in pain scores.

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Published

2020-09-08

How to Cite

Zwaard, B. C. V. D., Roerdink, R. L. ., & Hove, R. P. V. (2020). Increase in early wound leakage in total knee arthroplasty with local infiltrative analgesia (LIA) that includes epinephrine: a retrospective cohort study. Acta Orthopaedica, 91(6), 756–760. https://doi.org/10.1080/17453674.2020.1815975