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Does local infiltration analgesia in total joint arthroplasty offer any protection from prosthetic joint infections?

Varun Tandra1, Manjunath Koti1, Sandeep Kohli1

  • 1Department of Trauma and Orthopaedics, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, Farnborough Common, UK.

Journal of Perioperative Practice
|December 1, 2022
PubMed

Insights

Local anesthetics do not inhibit common prosthetic joint infection bacteria. This suggests infiltration for pain management offers no protection against surgical site infections and may affect diagnostic tests.

Area of Science:

  • Microbiology
  • Anesthesiology
  • Orthopedic Surgery

Background:

  • Local anesthetic agents are increasingly reported to possess antimicrobial properties.
  • The efficacy of local anesthetics in inhibiting microbial growth varies significantly.
  • Perioperative pain management often involves local anesthetic infiltration, raising questions about potential surgical site infection (SSI) prevention.

Purpose of the Study:

  • To evaluate the antimicrobial activity of commonly used local anesthetics against key prosthetic joint infection pathogens.
  • To determine if local anesthetic infiltration provides protection against surgical site infections.

Main Methods:

  • Three prevalent prosthetic joint infection organisms (Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli) were selected.
  • Organisms were cultured on Mueller-Hinton agar plates.
  • Undiluted solutions of local anesthetics were applied to cultures; vancomycin and gentamicin discs served as controls.

Main Results:

  • None of the tested local anesthetic agents demonstrated the ability to inhibit the growth of Staphylococcus aureus, Staphylococcus epidermidis, or Escherichia coli.
  • Due to the lack of inhibition with undiluted agents, further experiments with diluted mixtures were not conducted.

Conclusions:

  • Local anesthetic infiltration is unlikely to offer perioperative protection against prosthetic joint infections.
  • The use of local anesthetics may potentially interfere with microbiological diagnostic tests.
Keywords:
Antimicrobial actionBupivacaineLidocaineLocal anaestheticsProsthetic joint infection

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