Best Infiltration Practices App

Hip and Knee Arthroplasty & Orthopedic Surgery

Best Infiltration Practices - local analgesic techniques for abdominal and orthopedic surgery

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Infiltration Technique Descriptions 10 Partial Knee Arthroplasty Injection solution includes bupivacaine liposomal injectable suspension (EXPAREL) 20 mL and 0.25% bupivacaine with epinephrine 30 mL. Normal saline 10-20 mL may be added if extra volume is needed. Notes: • The femoral, saphenous and posterior tibial nerves all innervate the knee with variable distributions. Therefore successful injection requires injecting all layers of the knee. • Extra medication can be injected into the quadriceps tendon and proximal perisoteum, a source of considerable patient pain, the medial meniscosynovial junction and the patellar branch of the saphenous nerve. • Injecting the subcutaneous layer may be omitted if the skin is very thin. • A few mLs should be reserved for the drain site. Infiltration Technique Local Analgesic Volume Step 1: Deep Injection of the Involved Compartment Aer exposing the knee joint and before the prostheses are in place, inject 10 mL into the deep structures. ▶ MEDIAL UNICOMPARTMENTAL: Inject into the anterior and posterior cruciate ligaments, the posterior medial capsule, the superficial and deep fibers of the medial collateral ligament, the periosteum around the cut surfaces of the medial femur and tibia, the peri-articular synovial reflections, the suprepatellar pouch and the medial soft-tissue envelope. ▶ LATERAL UNICOMPARTMENTAL: Inject into the lateral and posterior popliteus, lateral and anterior iliotibial band and its insertion on Gerdy's tubercle, and the lateral periosteum of the femur and tibia. Inject 10 mL into the quadriceps tendon and muscles and peri-patellar so tissue. Note: When injecting the posterior structures avoid the midline vascular bundle. Also avoid the peroneal nerve when injecting lateral structures. 20 mL Step 2: Mid-layer Injection Aer the prostheses are in place and while the cement cures, inject 10 mL into the deep dermal tissue planes, targeting the femoral, saphenous and posterior tibial nerve distributions. 10 mL Step 3: Superficial Injection e remaining 20 mL is injected into the subcutaneous layer and skin, more medially where the sensory nerves predominate. 20 mL

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