MAY 2015
|
The Surgical Technologist
|
207
Bupivacaine Liposome
Injectable Solutions
for Total Knee Arthroplasty Patients
L E A R N I N G O B J E C T I V E S
s
Explain the usage of bupivacaine
liposome in a total knee arthroplasty
s
Define femoral nerve and femoral
nerve block
s
Review the differences between
a femoral nerve block and a
bupivacaine liposome injectable
solution
s
Review the steps of a TKA while using
an injectable solution
s
List the benefits of using an
injectable solution during this
type of surgery
Paul Halfman, cst
Post-surgically, many patients who are recovering from total knee arthroplasty
(TKA) may suffer from quadriceps weakness due to a femoral nerve block they may
have received preoperatively. This weaknessmay delay their ability to participate in
physical therapy as they are unable to actively extend their leg. The administration
of a long-lasting local anesthetic such as a bupivacaine liposome injectable solu-
tion at the close of the procedure in the surgical wound has recently been used in
conjunction with and, in some cases, in place of a femoral nerve block in the hope of
eliminating this adverse effect while maintaining adequate analgesia.
F E M O R A L N E R V E B L O C K
A
femoral nerve block is a short-term local analgesic/anesthetic
administered to the femoral nerve which is the largest nerve
from the lumbar plexus. The nerve originates at the sec-
ond, third and fourth lumbar nerves and descends through the psoas
muscle. It eventually transverses below the inguinal ligament and into
the thigh. The femoral nerve supplies the muscular branches of the
iliacus, pectineus, the muscles of the anterior thigh and the articular
branches of the knee and hip. Examples of the pharmaceutical agents
typically used for the block are lidocaine, bupivacaine, mepivacaine
and ropivacaine which act as sodium channel blockers. Onset and
durations vary. For example, lidocaine has a rapid onset but a shorter
duration than bupivacaine. All of these injections may be prepackaged
with or without epinephrine.
The blockade results in the anesthesia of the muscles of the ante-
rior thigh and knee joint. It is performed at the inguinal crease typi-
cally with the aid of ultrasound and a peripheral nerve stimulator.