Systemic Ropivacaine Concentrations Following Local Infiltration Analgesia and Femoral Nerve Block in Older Patients Undergoing Total Knee Arthroplasty

Sigita Kazune,1,2 Inga Nurka,2 Matiss Zolmanis,2 Arturs Paulausks,3,4 Dace Bandere4,5 1Department of Anesthesiology and Intensive Care, Riga Stradins University, Riga, Latvia; 2Department of Anesthesiology, Hospital of Traumatology and Orthopedics, Riga, Latvia; 3Laboratory of Finished Dosage Forms, Faculty of Pharmacy, Riga Stradins University, Riga, Latvia; 4Baltic Biomaterials Centre of Excellence, Headquarters at Riga Technical University, Riga, Latvia; 5Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Riga Stradins University, Riga, LatviaCorrespondence: Sigita Kazune, Department of Anesthesiology, Hospital of Traumatology and Orthopaedics, 22 Duntes Street, Riga, LV-1013, Latvia, Tel +371 67399221, Fax +371 67392348, Email [email protected]: The study examined the pharmacokinetic profile of fixed formulation mixtures comprising 225 mg of ropivacaine for local infiltration analgesia with or without epinephrine, and femoral nerve block in older patients presenting for orthopedic surgery and explored potential influences of block type, age, and body weight on this profile.Patients and Methods: Twenty four patients scheduled for total knee arthroplasty were randomly assigned to three groups: femoral nerve block, local infiltration analgesia with epinephrine and local infiltration analgesia without epinephrine. Blood samples were collected at 10, 30, 60, and 120 min following the block and total plasma concentrations of ropivacaine were quantified by high performance liquid chromatography.Results: The mean individual peak total plasma concentrations of ropivacaine in local infiltration analgesia with and without epinephrine, and femoral nerve block group were 0.334, 0.490 and 0.545 μg mL− 1 (p = 0.16). Local infiltration with epinephrine group had significantly lower plasma ropivacaine concentrations at 30, 60 and 120 minutes. The plasma ropivacaine concentrations exceeded 2.2 μg mL− 1 in one patient. Age, but not body weight, had a moderate correlation with peak plasma ropivacaine concentration (r = 0.37, p = 0.08).Conclusion: Administration of a fixed 225 mg dose of ropivacaine for local infiltration analgesia with epinephrine and femoral nerve block results in plasma ropivacaine concentrations below the toxicity threshold, indicating their safety. The use of local infiltration analgesia with epinephrine provides a greater safety margin, as local infiltration analgesia without epinephrine may lead to ropivacaine concentrations associated with symptoms of local anesthetic toxicity.Keywords: arthroplasty, anesthetic techniques, regional, anesthetics local, ropivacaine, toxicity, local anesthetic

The Influence of Active Workstations on Work Performance, Productivity Indicators and Sedentary Time: A Systematic Review

The most of strategies to promote physical activity in workplaces interfere with work tasks and many organizations declined these programs. The aim of this review is to understand the impact of the active workstations on the performance and productivity indicators, and also on the reduction of the sedentary time. This review applied PRISMA methodology. 389 studies were identified by searching the different databases and 12 studies were selected, fulfilling the screening and eligibility criteria. The implementation of active workstations did not have a significant impact in terms of performance and productivity. However, some of indicators revealed some positive changes, namely at sit-standing, walking and cycling conditions. All active interventions had positive effects on the reduction of sedentary work time. However, it is essential that active interventions have promising effects for employers accept the challenge.info:eu-repo/semantics/publishedVersio

Mortality after surgery in Europe: a 7 day cohort study

Background: Clinical outcomes after major surgery are poorly described at the national level. Evidence of heterogeneity between hospitals and health-care systems suggests potential to improve care for patients but this potential remains unconfirmed. The European Surgical Outcomes Study was an international study designed to assess outcomes after non-cardiac surgery in Europe.Methods: We did this 7 day cohort study between April 4 and April 11, 2011. We collected data describing consecutive patients aged 16 years and older undergoing inpatient non-cardiac surgery in 498 hospitals across 28 European nations. Patients were followed up for a maximum of 60 days. The primary endpoint was in-hospital mortality. Secondary outcome measures were duration of hospital stay and admission to critical care. We used χ² and Fisher’s exact tests to compare categorical variables and the t test or the Mann-Whitney U test to compare continuous variables. Significance was set at p<0·05. We constructed multilevel logistic regression models to adjust for the differences in mortality rates between countries.Findings: We included 46 539 patients, of whom 1855 (4%) died before hospital discharge. 3599 (8%) patients were admitted to critical care after surgery with a median length of stay of 1·2 days (IQR 0·9–3·6). 1358 (73%) patients who died were not admitted to critical care at any stage after surgery. Crude mortality rates varied widely between countries (from 1·2% [95% CI 0·0–3·0] for Iceland to 21·5% [16·9–26·2] for Latvia). After adjustment for confounding variables, important differences remained between countries when compared with the UK, the country with the largest dataset (OR range from 0·44 [95% CI 0·19 1·05; p=0·06] for Finland to 6·92 [2·37–20·27; p=0·0004] for Poland).Interpretation: The mortality rate for patients undergoing inpatient non-cardiac surgery was higher than anticipated. Variations in mortality between countries suggest the need for national and international strategies to improve care for this group of patients.Funding: European Society of Intensive Care Medicine, European Society of Anaesthesiology