Evidence map›Paper›PMID 39573988›Full record

Observational studyBMC anesthesiology2024

Incidence of local anesthetic systemic toxicity in patients receiving bupivacaine infiltration analgesia for total joint arthroplasty under general anesthesia: a retrospective single-center study.

Yung-Fong Tsai, Yen-Chu Lin, Pang-Hsin Hsieh, Jiin-Tarng Liou, Yung-Tai Chung, Bo-Fu Shih, Min-Wen Yang, Fu-Chao Liu, Huan-Tang Lin

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in BMC anesthesiology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Review
  2. Article
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Yung-Fong Tsai *Department of Anesthesiology, Chang Gung Memorial Hospital at Linkou, Taoyuan, 333, Taiwan.
Yen-Chu Lin *Department of Anesthesiology, Chang Gung Memorial Hospital at Linkou, Taoyuan, 333, Taiwan.
Pang-Hsin HsiehCollege of Medicine, Chang Gung University, Taoyuan, 333, Taiwan.
Jiin-Tarng LiouDepartment of Anesthesiology, Chang Gung Memorial Hospital at Linkou, Taoyuan, 333, Taiwan.
Yung-Tai ChungDepartment of Anesthesiology, Chang Gung Memorial Hospital at Linkou, Taoyuan, 333, Taiwan.
Bo-Fu ShihDepartment of Anesthesiology, Chang Gung Memorial Hospital at Linkou, Taoyuan, 333, Taiwan.
Min-Wen YangDepartment of Anesthesiology, Chang Gung Memorial Hospital at Linkou, Taoyuan, 333, Taiwan.
Fu-Chao LiuDepartment of Anesthesiology, Chang Gung Memorial Hospital at Linkou, Taoyuan, 333, Taiwan.
Huan-Tang LinDepartment of Anesthesiology, Chang Gung Memorial Hospital at Linkou, Taoyuan, 333, Taiwan. sanctuary12@cgmh.org.tw.

Funding

Chang Gung Memorial Hospital, Taiwan CMRPG3K1051-3Chang Gung Memorial Hospital, Taiwan CMRPG3N0591Ministry of Science and Technology, Taiwan MOST 111-2320-B-182A-008-MY3
6 · The paper itself

Abstract

backgroundLocal infiltration analgesia (LIA) is a crucial component of multimodal analgesia that enhances recovery after total hip arthroplasty (THA) and knee arthroplasty (TKA). However, LIA can cause fatal local anesthetic systemic toxicity (LAST). The incidences of LIA-induced LAST in different surgeries and anesthetic agents have not been well investigated.

methodsThis observational study enrolled 1,267 adult patients who received LIA with bupivacaine for primary THA or TKA under general anesthesia at a single medical center between January 2020 and October 2021. LAST incidence was graded by severity: severe (refractory seizure or arrhythmia requiring lipid rescue), major (seizure or arrhythmia requiring prompt medication), and minor (all other) events. Patient demographics, surgical and anesthesia details, recovery profiles, and LAST incidences were recorded and analyzed.

resultsThe incidence of severe LAST events was 2.41 per 1000 in unilateral THA, 0 in TKA, and 3.16 per 1000 in the entire cohort. The odds ratio of developing major LAST events was 4.35 in patients undergoing unilateral THA compared with those undergoing unilateral TKA in a matched comparison. Patients who underwent bilateral THA had the highest risk of developing LIA-induced LAST. Additionally, patients using propofol infusion for anesthesia maintenance had a lower risk of seizures and tremors than those using sevoflurane inhalation. The odds ratio of major LAST events was 0.47 in matched comparisons.

conclusionsLIA was associated with a significantly higher risk of LAST in the THA group than in the TKA group. Propofol maintenance reduces the likelihood of seizures and tremors compared with sevoflurane inhalation. Exploring strategies to reduce the incidence of LIA-induced LAST is essential to improve perioperative patient safety.

Indexed as

Anesthesia, GeneralAnesthetics, LocalArthroplasty, Replacement, HipArthroplasty, Replacement, KneeBupivacaineAgedAnalgesiaFemaleHumansIncidenceMaleMiddle AgedRetrospective StudiesAnesthetics, LocalBupivacaineLipid emulsionLocal anesthetic systemic toxicityLocal infiltration analgesiaTotal hip arthroplastyTotal knee arthroplasty

Identifiers

PMID39573988
PMCPMC11580633

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.