{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:14:09Z","timestamp":1792109649552,"version":"4.4.0"},"reference-count":15,"publisher":"BMJ","issue":"4","funder":[{"name":"University of Utah Department of Anesthesiology","award":["Research Council Next Stage Grant"],"award-info":[{"award-number":["Research Council Next Stage Grant"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2018,11,3]]},"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:sec>\n                  <jats:title>Background and objectives<\/jats:title>\n                  <jats:p>A common analgesic technique for total knee arthroplasty (TKA) is to inject local anesthetic into the periarticular tissue during surgery, known as local infiltration analgesia (LIA). Since the solution used typically contains a large amount of local anesthetic, concerns arise about exceeding the maximum dosage when adding a peripheral nerve block. Little research exists that addresses serum ropivacaine concentrations following LIA combined with peripheral nerve block. We hypothesized that after combining LIA and adductor canal blockade (ACB), serum ropivacaine concentrations would remain below levels associated with local anesthetic toxicity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This was a prospective observational study that included 14 subjects undergoing TKA with intraoperative LIA containing 270 mg ropivacaine with epinephrine. Patients weighing less than 80 kg were excluded due to standardized dosing by our pharmacy. Seven patients were assigned consecutively to receive LIA alone (Group LIA) and seven were assigned to receive LIA plus ACB with 100 mg ropivacaine with epinephrine (Group LIA+ACB). Venous serum ropivacaine concentrations were measured over 24 hours.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Peak serum concentrations (Cmax) in Group LIA ranged from 0.23 to 0.75 \u00b5g\/mL and occurred at times from 4 to 24 hours. Cmax in Group LIA+ACB ranged from 0.46 to 1.00 \u00b5g\/mL and occurred at times from 4 to 8 hours. No participants demonstrated signs or symptoms of local anesthetic toxicity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Total serum concentration of ropivacaine after LIA using 270 mg ropivacaine with and without an additional 100 mg perineural ropivacaine remained well below the toxicity threshold of 3.0 \u00b5g\/mL at all time points. Additional studies are needed to ascertain the safety of combining LIA with peripheral nerve blockade.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rapm-2018-100043","type":"journal-article","created":{"date-parts":[[2019,1,12]],"date-time":"2019-01-12T02:45:55Z","timestamp":1547261155000},"page":"478-482","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["Serum ropivacaine levels after local infiltration analgesia during total knee arthroplasty with and without adductor canal block"],"prefix":"10.1136","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8019-8253","authenticated-orcid":false,"given":"Katherine L","family":"Koniuch","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, University of Utah Hospital, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael Jay","family":"Buys","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, University of Utah Hospital, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blake","family":"Campbell","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, University of Utah Hospital, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy M","family":"Gililland","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of Utah Hospital, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher E","family":"Pelt","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of Utah Hospital, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan L","family":"Pace","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, University of Utah Hospital, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken B","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, University of Utah Hospital, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,1,11]]},"reference":[{"key":"2025101111183846000_44.4.478.1","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1097\/AJP.0000000000000631","article-title":"Comparison of the efficacy of different analgesia treatments for total knee arthroplasty: a network meta-analysis","volume":"34","author":"Dong","year":"2018","journal-title":"Clin J 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arthroplasty","volume":"70","author":"Brydone","year":"2015","journal-title":"Anaesthesia"},{"key":"2025101111183846000_44.4.478.9","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0000000000000727"},{"key":"2025101111183846000_44.4.478.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.rapm.2004.08.003"},{"key":"2025101111183846000_44.4.478.11","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0000000000000636"},{"key":"2025101111183846000_44.4.478.12","doi-asserted-by":"publisher","DOI":"10.1177\/1060028016653607"},{"key":"2025101111183846000_44.4.478.13","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1007\/s12306-017-0519-3","article-title":"Comparative analysis of influence of adductor canal block and multimodal periarticular infiltration versus adductor canal block alone on pain and knee range of movement after total knee arthroplasty: a prospective non-randomised study","volume":"102","author":"Sankineani","year":"2018","journal-title":"Musculoskelet Surg"},{"key":"2025101111183846000_44.4.478.14","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000008103","article-title":"Adductor canal block with local infiltrative analgesia compared with local infiltrate analgesia for pain control after total knee arthroplasty: a meta-analysis of randomized controlled trials","volume":"96","author":"Xing","year":"2017","journal-title":"Medicine"},{"key":"2025101111183846000_44.4.478.15","doi-asserted-by":"crossref","first-page":"1470","DOI":"10.1016\/j.arth.2016.11.049","article-title":"Does addition of multimodal periarticular analgesia to adductor canal block improve lengths of stay, pain, discharge status, and opioid use after total knee arthroplasty?","volume":"32","author":"Gwam","year":"2017","journal-title":"J Arthroplasty"}],"container-title":["Regional Anesthesia &amp; Pain 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