study of the effects of two forms of epidural bupivacaine on postoperative pain following total knee replacement - Trial PACTR201502001010803

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Summary

Postoperative pain after total knee arthroplasty (TKA) was ranked by a broad cross section of patient as their highest concern, highlighting the necessity for prolonged postoperative analgesia. Regional anesthesia has been commonly used as a strategy to mitigate postoperative pain. epidural anesthesia is considered as the gold standard in reliving postoperative pain however prolonged infusions of large amounts of local anesthetic may be accompanied by local anesthetic systemic toxicity. Therefore research have focused on reducing the local anesthetic doses.Bupivacaine is one of the most commonly employed agents in epidural anesthesia and analgesia. However only plain marcaine has been used for this purpose. Hyperbaric marcaine is commonly used for spinal anesthesia because it tends to spread caudally by the effect of its density to avoid total spinal complication however it have not tried for epidural anesthesia. We postulate that the higher density of hyperbaric marcaine would lead to slower diffusion of the anesthetic solution and better block quality than the use of plain marcaine.We hypothesize that the use of hyperbaric bupivacaine (heavy marcaine) in epidural anesthesia would prolong duration of the block, postoperative analgesia and volume of local anesthetic infusion so decreases local anesthetic toxicity.

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