The Journal of Bone and Joint Surgery (American). 2009;91:2238-2240.
doi:10.2106/JBJS.H.00723
© 2009 The Journal of Bone and Joint Surgery, Inc.
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Third-Degree Heart Block Associated with Bupivacaine Infusion Following Total Knee Arthroplasty

A Case Report

David C. Hay, MD1, Robert E. Mayle, Jr., MD1 and Stuart B. Goodman, MD, PhD1

1 Department of Orthopaedic Surgery, Stanford University Medical Center, 300 Pasteur Drive, Room R171, Stanford, CA 94305-2200. E-mail address for R.E. Mayle Jr.: rmayle@stanford.edu

Investigation performed at the Department of Orthopaedic Surgery, Stanford University, Stanford, California

The first 150 words of the full text of this article appear below.


   Introduction
 
Total knee arthroplasty is one of the most successful operations performed. Multiple modalities are utilized for pain management in the perioperative period. Regional anesthesia is a common, effective method associated with high patient satisfaction. It typically provides exceptional local pain control without the systemic side effects that have been associated with oral or parenteral narcotics. Alleviation of pain allows for earlier mobilization and potentially shorter hospital stays. However, continuous infusion of a long-acting local anesthetic is not without risk. Case reports of severe complications such as hypotension, arrhythmia, seizure, and cardiovascular collapse have been reported, but all involved intra-articular injections or a single injection of a large dose of anesthetic medication to attain a regional block1-6. We found no reports of arrhythmia in association with an indwelling catheter in patients who were receiving regional anesthesia.

We present the case of a patient in whom a third-degree heart block developed . . . [Full Text of this Article]


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