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Local Anesthesia following TKR

- intraoperative injection:
             - 300 mg ropivacaine (0.2%) (150 mL) + 30 mg ketorolac (1 mL) + 500 µg of epinephrine (1:1000) (0.5 mL) (prepared on the sterile field)
             - 18 gauge needle is used to inject in 3 equal 50 mL doses into each of 3 locations:
                    (a) posterior capsule
                    (b) medial, lateral capsule and the edges of the capsular incision
                    (c) subcutaneous tissue along both edges of the incision
      - 21 hour postoperative injection:
             - at the time of surgery standard 17 or 19 gauge epidural catheter that inserted with a tuohy needle (epidural needle)

             - only leave 4" out of the skin and put it thru the VMO so that the muscle seals the hole when removed;
             - 100 mg (more does not work any better or last longer);
     - references:
             - Efficacy of Periarticular Multimodal Drug Injection in Total Knee Arthroplasty. A Randomized Trial
             - Analgesic efficacy of local anaesthetic wound administration in knee arthroplasty: volume vs concentration.
             - Local Infiltration Analgesia in TKA Patients Reduces Length of Stay and Postoperative Pain Scores
             - Reduced morphine consumption and pain intensity with local infiltration analgesia (LIA) following total knee arthroplasty.
             - A randomized, controlled trial comparing local infiltration analgesia with epidural infusion for total knee arthroplasty
             - Pain control after total knee arthroplasty: a randomized trial comparing local infiltration anesthesia and continuous femoral block.
             - Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty: a randomized clinical trial.
             - Current and Innovative Pain Management Techniques in Total Knee Arthroplasty
Single periarticular local infiltration analgesia reduces opiate consumption until 48 hours after total knee arthroplasty. A randomized placebo-controlled trial involving 56 patients.


             - Intraarticular analgesia versus epidural plus femoral nerve block after TKA: a randomized, double-blind trial
             - Local anesthetics as antimicrobial agents: a review.
             - Comparison of the antibacterial activity of lidocaine 1% versus alkalinized lidocaine in vitro.
             - Effect of lidocaine and epinephrine on Staphylococcus aureus in a guinea pig model of surgical wound infection.
             - Antimicrobial activity of lidocaine against bacteria associated with nosocomial wound infection.
             - Drug contamination from opening glass ampules.

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