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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2 Infiltration Technique Descriptions THA Posterior Approach 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. Infiltration Technique Local Analgesic Volume Step 1: Deep Injection Aer the joint is prepared for implantation, inject 20 mL into the anterior capsule and periosteum, the inferior capsule, the superior capsule and periosteum, the psoas tendon sheath, the superior deep layer of abductors, and the anterior femoral periosteum. 20 mL Note: Observe caution regarding the posterior injection due to the proximity of the sciatic nerve. Step 2: Posterior Injection Inject 10 mL into the short external rotators and posterior capsule (aer repair), the abductors, the anterior femoral so tissues, the periosteum of the trochanter and the vastus lateralis. 10 mL Note: Observe caution regarding the posterior injection due to the proximity of the sciatic nerve. Step 3: Superficial Injection Aer insertion of the femoral prosthesis, inject the remaining 20 mL into the tensor layer, ilio-tibial band, gluteus maximus, subcutaneous layer and skin. 20 mL Note: For revisions: • Extend the deep injections, prior to stem placement but following placement of the acetabular cup: ▶ more broadly superiorly in the region of the peri-acetabular periosteum ▶ further along the femoral periosteum ▶ into the vastus lateralis & deep quadriceps muscles • Extend the mid-layer injections, being careful to avoid the sciatic nerve: ▶ into the gluteus maximus ▶ into the interosseus membrane • Extend the superficial injections: ▶ more broadly along the deep tissues & subcutaneous layers

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