Key Points
Î Over one million hip and knee arthroplasties were performed in the
United States in 2010 (http://www.cdc.gov/nchs/fastats/insurg.htm).
Many can benefit from local analgesic wound infiltration.
Î Despite recent advances, 86% of patients report moderate to extreme
pain following surgery.
Î Pain is the most common cause of hospital admissions after
ambulatory surgery.
Î Multimodal strategies using two or more analgesic agents and
including administration of local analgesics are recommended
by surgical pain guidelines — eg, American Pain Society (APS),
American Society of Anesthesiologists (ASA), American Society of
PeriAnesthesia Nurses (ASPAN), Department of Defense (DOD).
1-4, 9, 20
Î Since their clinical use was first demonstrated more than 120 years ago,
local analgesics have provided an alternative to general anesthesia and
an adjunct to better managing surgical pain that has proved beneficial
for both patients and practitioners.
10, 12, 13, 15, 19
Î Managing surgical pain with minimal use of opioids has been shown to
accelerate patient recovery; reduce complications, hospital stays and
readmissions; and improve overall patient outcomes.
10, 12, 13, 15, 19
Î Wound infiltration with local analgesics has demonstrated benefits for
reducing surgical pain and the use of opioids, minimizing expensive
complications that cause patient harm and thereby shortening hospital
stays and reducing readmissions.
10, 12, 13, 18
Î The recent addition of a 72-hour liposome formulation of bupivacaine
substantially and favorably alters the paradigm for evaluating and
using surgical wound infiltration in joint arthroplasty to improve pain
scores, significantly reducing the need for opioids and improving
patient satisfaction.
7
Î Always consider maximum dose and patient weight when infiltrating.
Because amide-type local anesthetics such as bupivacaine are
metabolized by the liver, they should be used cautiously in patients
with hepatic disease. Patients with severe hepatic disease are at a
greater risk of developing toxic plasma concentrations.
Î Improving local analgesic administration techniques can improve
surgical pain outcomes and benefit patients. This is the goal
of the Best Infiltration Practices Working Group and its expert
recommendations.
ÎInfiltration techniques vary from procedure to procedure, requiring
knowledge of each surgical site and its anatomy to produce optimal results.