The preventive efficacy of lipid emulsion on the occurrence of local anesthetic systemic toxicity in patients receiving local infiltration analgesia for total joint arthroplasty.
Humans
Male
Female
Anesthetics, Local
/ administration & dosage
Aged
Retrospective Studies
Arthroplasty, Replacement, Hip
/ adverse effects
Middle Aged
Arthroplasty, Replacement, Knee
/ adverse effects
Bupivacaine
/ administration & dosage
Pain, Postoperative
/ prevention & control
Pilot Projects
Analgesia
/ methods
Anesthesia, Local
/ methods
Fat Emulsions, Intravenous
/ administration & dosage
Lipid emulsion
Local anesthetic systemic toxicity
Local infiltration analgesia
Total hip arthroplasty
Total knee arthroplasty
Journal
Journal of orthopaedic surgery and research
ISSN: 1749-799X
Titre abrégé: J Orthop Surg Res
Pays: England
ID NLM: 101265112
Informations de publication
Date de publication:
28 Oct 2024
28 Oct 2024
Historique:
received:
23
07
2024
accepted:
19
10
2024
medline:
29
10
2024
pubmed:
29
10
2024
entrez:
29
10
2024
Statut:
epublish
Résumé
Motor-sparing local infiltration analgesia (LIA) enhances recovery after total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, LIA can induce local anesthetic systemic toxicity (LAST), sometimes necessitating rescue lipid emulsion therapy. Our institute initiated a pilot study to pretreat patients with lipid emulsion (SMOFlipid This retrospective study enrolled 1,621 adult patients who received LIA with bupivacaine (2-3 mg/kg, maximum 300 mg) for unilateral primary THA or TKA under general anesthesia between January 2020 and April 2022. A total of 439 patients received lipid pretreatment, while 1,182 did not. Demographics, surgical and anesthesia profiles, along with LAST events affecting the neurological, cardiovascular, and respiratory systems, were compared after propensity score matching for age, sex, body mass index (BMI), and surgery type. The incidence of severe LAST events requiring rescue lipid emulsion slightly decreased after lipid pretreatment (from 2.54 to 2.28 per 1000). Lipid pretreatment significantly reduced the incidence of bradycardia and new-onset arrhythmia (odds ratio: 0.13, adjusted p-value: 0.024) but increased postoperative opioid requirement (odds ratio: 1.71, adjusted p-value: 0.032) after Benjamini-Hochberg correction for multiplicity. The efficacy of lipid pretreatment (SMOFlipid
Sections du résumé
BACKGROUND
BACKGROUND
Motor-sparing local infiltration analgesia (LIA) enhances recovery after total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, LIA can induce local anesthetic systemic toxicity (LAST), sometimes necessitating rescue lipid emulsion therapy. Our institute initiated a pilot study to pretreat patients with lipid emulsion (SMOFlipid
METHODS
METHODS
This retrospective study enrolled 1,621 adult patients who received LIA with bupivacaine (2-3 mg/kg, maximum 300 mg) for unilateral primary THA or TKA under general anesthesia between January 2020 and April 2022. A total of 439 patients received lipid pretreatment, while 1,182 did not. Demographics, surgical and anesthesia profiles, along with LAST events affecting the neurological, cardiovascular, and respiratory systems, were compared after propensity score matching for age, sex, body mass index (BMI), and surgery type.
RESULTS
RESULTS
The incidence of severe LAST events requiring rescue lipid emulsion slightly decreased after lipid pretreatment (from 2.54 to 2.28 per 1000). Lipid pretreatment significantly reduced the incidence of bradycardia and new-onset arrhythmia (odds ratio: 0.13, adjusted p-value: 0.024) but increased postoperative opioid requirement (odds ratio: 1.71, adjusted p-value: 0.032) after Benjamini-Hochberg correction for multiplicity.
CONCLUSIONS
CONCLUSIONS
The efficacy of lipid pretreatment (SMOFlipid
Identifiants
pubmed: 39468594
doi: 10.1186/s13018-024-05189-7
pii: 10.1186/s13018-024-05189-7
doi:
Substances chimiques
Anesthetics, Local
0
Bupivacaine
Y8335394RO
Fat Emulsions, Intravenous
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
697Subventions
Organisme : Chang Gung Memorial Hospital, Linkou
ID : CMRPG3N0591
Organisme : Chang Gung Memorial Hospital, Linkou
ID : CMRPG3K1051-3
Organisme : Ministry of Science and Technology, Taiwan
ID : MOST 111-2320-B-182A-008-MY3
Informations de copyright
© 2024. The Author(s).
Références
Schwartz AM, Farley KX, Guild GN, Bradbury TL. Jr. Projections and epidemiology of revision hip and knee arthroplasty in the United States to 2030. J Arthroplasty. 2020;35(6S):S79–85.
doi: 10.1016/j.arth.2020.02.030
pubmed: 32151524
pmcid: 7239745
Soffin EM, YaDeau JT. Enhanced recovery after surgery for primary hip and knee arthroplasty: a review of the evidence. Br J Anaesth. 2016;117(suppl 3):iii62–72.
doi: 10.1093/bja/aew362
pubmed: 27940457
Qi BC, Yu J, Qiao WS. Comparison of intrathecal morphine versus local infiltration analgesia for pain control in total knee and hip arthroplasty: a meta-analysis. Med (Baltim). 2020;99(36):e21971.
doi: 10.1097/MD.0000000000021971
Andersen LO, Kehlet H. Analgesic efficacy of local infiltration analgesia in hip and knee arthroplasty: a systematic review. Br J Anaesth. 2014;113(3):360–74.
doi: 10.1093/bja/aeu155
pubmed: 24939863
Chen DW, Hu CC, Chang YH, Lee MS, Chang CJ, Hsieh PH. Intra-articular bupivacaine reduces postoperative pain and meperidine use after total hip arthroplasty: a randomized, double-blind study. J Arthroplasty. 2014;29(12):2457–61.
doi: 10.1016/j.arth.2013.12.021
pubmed: 24439998
Neal JM, Barrington MJ, Fettiplace MR, Gitman M, Memtsoudis SG, Morwald EE, et al. The third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on local anesthetic systemic toxicity: executive Summary 2017. Reg Anesth Pain Med. 2018;43(2):113–23.
doi: 10.1097/AAP.0000000000000720
pubmed: 29356773
Mitchell K, Cai E, Miller B, Jenkins K, McAllister RK, Fettiplace M, et al. Local anesthetic systemic toxicity from local infiltration anesthesia in total joint arthroplasty: a single center retrospective study. Reg Anesth Pain Med. 2023. https://doi.org/10.1136/rapm-2023-104880 .
doi: 10.1136/rapm-2023-104880
pubmed: 37620115
Fettiplace MR, Weinberg G. The mechanisms underlying lipid resuscitation therapy. Reg Anesth Pain Med. 2018;43(2):138–49.
doi: 10.1097/AAP.0000000000000719
pubmed: 29356774
Kuo I, Akpa BS. Validity of the lipid Sink as a mechanism for the reversal of local anesthetic systemic toxicity a physiologically based pharmacokinetic model study. Anesthesiology. 2013;118(6):1350–61.
doi: 10.1097/ALN.0b013e31828ce74d
pubmed: 23459217
Lee SH, Sohn JT. Mechanisms underlying lipid emulsion resuscitation for drug toxicity: a narrative review. Korean J Anesthesiol. 2023;76(3):171–82.
doi: 10.4097/kja.23031
pubmed: 36704816
pmcid: 10244607
Kim HJ, Kim HS, Jung JR, Kim HY, Lynch C 3rd, Park WK. Lipid emulsion restoration of myocardial contractions after Bupivacaine-Induced Asystole in Vitro: A Benefit of Long- and medium-chain triglyceride over long-chain triglyceride. Anesth Analg. 2020;131(3):917–27.
Leguina-Ruzzi AA, Ortiz R. Current evidence for the Use of Smoflipid
pubmed: 30584476
pmcid: 6280253
Burjorjee J, Phelan R, Hopman WM, Ho AM, Nanji S, Jalink D, Mizubuti GB. Plasma bupivacaine levels (total and free/unbound) during epidural infusion in liver resection patients: a prospective, observational study. Reg Anesth Pain Med. 2022. https://doi.org/10.1136/rapm-2022-103683 .
doi: 10.1136/rapm-2022-103683
pubmed: 36002226
Kurosaka K, Tsukada S, Ogawa H, Nishino M, Yoshiya S, Hirasawa N. Comparison of early-stage and late-stage Periarticular Injection for Pain Relief after total hip arthroplasty: a double-blind randomized controlled trial. J Arthroplasty. 2020;35(5):1275–80.
doi: 10.1016/j.arth.2019.12.020
pubmed: 31917054
Heppolette CAA, Brunnen D, Bampoe S, Odor PM. Clinical pharmacokinetics and pharmacodynamics of Levobupivacaine. Clin Pharmacokinet. 2020;59(6):715–45.
doi: 10.1007/s40262-020-00868-0
pubmed: 32034727
Sohn JT. Lipid emulsion treatment for ventricular tachycardia induced by the toxicity of multiple herbs. Clin Exp Emerg Med. 2020;7(2):139–40.
doi: 10.15441/ceem.20.014
pubmed: 32635706
pmcid: 7348676
Gou J. On dependence assumption in p-value based multiple test procedures. J Biopharm Stat. 2023;33(5):596–610.
doi: 10.1080/10543406.2022.2162066
pubmed: 36607042
Wainwright TW. Enhanced recovery after surgery (ERAS) for hip and knee replacement-why and how it should be implemented following the COVID-19 pandemic. Med (Kaunas) 2021;57(1).
Campagner A, Milella F, Guida S, Bernareggi S, Banfi G, Cabitza F. Assessment of fast-track pathway in hip and knee replacement surgery by Propensity score matching on patient-reported outcomes. Diagnostics (Basel). 2023;13(6).
Wainwright TW, Gill M, McDonald DA, Middleton RG, Reed M, Sahota O, et al. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: enhanced recovery after surgery (ERAS((R))) Society recommendations. Acta Orthop. 2020;91(1):3–19.
doi: 10.1080/17453674.2019.1683790
pubmed: 31663402
Ma HH, Chou TA, Tsai SW, Chen CF, Wu PK, Chen WM. The efficacy of intraoperative periarticular injection in total hip arthroplasty: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2019;20(1):269.
doi: 10.1186/s12891-019-2628-7
pubmed: 31153361
pmcid: 6545218
Hong B, Oh C, Jo Y, Chung W, Park E, Park H, Yoon S. The Effect of Intravenous Dexamethasone and Dexmedetomidine on Analgesia Duration of Supraclavicular Brachial Plexus Block: a Randomized, Four-Arm, Triple-Blinded, placebo-controlled trial. J Pers Med. 2021;11(12).
Knudsen K, Beckman Suurkula M, Blomberg S, Sjovall J, Edvardsson N. Central nervous and cardiovascular effects of i.v. infusions of ropivacaine, bupivacaine and placebo in volunteers. Br J Anaesth. 1997;78(5):507–14.
doi: 10.1093/bja/78.5.507
pubmed: 9175963
Affas F, Eksborg S, Wretenberg P, Olofsson C, Stiller CO. Ropivacaine pharmacokinetics after local infiltration analgesia in hip arthroplasty. Anesth Analg. 2014;119(4):996–9.
doi: 10.1213/ANE.0000000000000364
pubmed: 25025588
Gromov K, Grassin-Delyle S, Foss NB, Pedersen LM, Nielsen CS, Lamy E, et al. Population pharmacokinetics of ropivacaine used for local infiltration anaesthesia during primary total unilateral and simultaneous bilateral knee arthroplasty. Br J Anaesth. 2021;126(4):872–80.
doi: 10.1016/j.bja.2020.11.038
pubmed: 33455802
Miller RJ, Cameron AJ, Dimech J, Orec RJ, Lightfoot NJ. Plasma ropivacaine concentrations following local infiltration analgesia in total knee arthroplasty: a pharmacokinetic study to Determine Safety following fixed-dose administration. Reg Anesth Pain Med. 2018;43(4):347–51.
doi: 10.1097/AAP.0000000000000727
pubmed: 29369957
Bakker SMK, Fenten MGE, van den Touw DJ, Heesterbeek PJC, Scheffer GJ, Stienstra R. Pharmacokinetics of 400 mg locally infiltrated Ropivacaine after total knee arthroplasty without Perioperative Tourniquet Use. Reg Anesth Pain Med. 2018;43(7):699–704.
pubmed: 29905628
Kazune S, Nurka I, Zolmanis M, Paulausks A, Bandere D. Systemic ropivacaine concentrations following local infiltration analgesia and femoral nerve block in older patients undergoing total knee arthroplasty. Local Reg Anesth. 2023;16:143–51.
doi: 10.2147/LRA.S425353
pubmed: 37731601
pmcid: 10508276
Feely J, Grimm T. A comparison of drug protein binding and alpha 1-acid glycoprotein concentration in Chinese and caucasians. Br J Clin Pharmacol. 1991;31(5):551–2.
doi: 10.1111/j.1365-2125.1991.tb05579.x
pubmed: 1888624
pmcid: 1368475
Riff C, Le Caloch A, Dupouey J, Allanioux L, Leone M, Blin O et al. Local anesthetic plasma concentrations as a Valuable Tool to confirm the diagnosis of local anesthetic systemic toxicity? A report of 10 years of experience. Pharmaceutics. 2022;14(4).
Fettiplace MR, McCabe DJ. Lipid emulsion improves survival in animal models of local anesthetic toxicity: a meta-analysis. Clin Toxicol (Phila). 2017;55(7):617–23.
doi: 10.1080/15563650.2017.1288911
pubmed: 28346007
Jaffal K, Chevillard L, Megarbane B. Lipid emulsion to treat Acute poisonings: mechanisms of action, indications, and controversies. Pharmaceutics. 2023;15(5).
Dureau P, Charbit B, Nicolas N, Benhamou D, Mazoit JX. Effect of Intralipid(R) on the dose of Ropivacaine or Levobupivacaine tolerated by volunteers: a clinical and pharmacokinetic study. Anesthesiology. 2016;125(3):474–83.
doi: 10.1097/ALN.0000000000001230
pubmed: 27404223
Weinberg GL, VadeBoncouer T, Ramaraju GA, Garcia-Amaro MF, Cwik MJ. Pretreatment or resuscitation with a lipid infusion shifts the dose-response to bupivacaine-induced asystole in rats. Anesthesiology. 1998;88(4):1071–5.
doi: 10.1097/00000542-199804000-00028
pubmed: 9579517
Nie H, Bai Z, Li Z, Yan L, Chen XX. Intravenous lipid emulsion modifies synaptic transmission in hippocampal CA1 pyramidal neurons after bupivacaine-induced central nervous system toxicity. J Neurochem. 2020;154(2):144–57.
doi: 10.1111/jnc.14924
pubmed: 31758799
Chen Y, Zhang J, Chen Z, Wang Q, Li B, Lai R, et al. Lipid emulsion pretreatment decreased the Maximum Total and Free plasma concentration of levobupivacaine for femoral and sciatic nerve block in below-knee fracture surgery. Reg Anesth Pain Med. 2018;43(8):838–43.
pubmed: 29923955
Hayes BD, Gosselin S, Calello DP, Nacca N, Rollins CJ, Abourbih D, et al. Systematic review of clinical adverse events reported after acute intravenous lipid emulsion administration. Clin Toxicol (Phila). 2016;54(5):365–404.
doi: 10.3109/15563650.2016.1151528
pubmed: 27035513