Aims. To study the safety of autotransfusion following local infiltration analgesia (LIA) with ropivacaine. Background. Knowledge of blood concentrations of ropivacaine after LIA and autotransfusion is crucial. However, very limited data are available for toxicological risk assessment. Methods. Autotransfusion was studied in patients after total knee arthroplasty (TKA: ) and total hip arthroplasty (THA: ) with LIA using 200？mg ropivacaine, supplemented with two postoperative bolus injections (150？mg ropivacaine). Drainage blood was reinfused within 6？h postoperatively. Results. Reinfusion caused a significant increase in the serum concentration of total ropivacaine for TKA from (mean ± SD) to ？μg/mL ( ) and a nonsignificant increase for THA from to ？μg/mL. The maximum free (unbound) concentration after reinfusion was 0.038？μg/mL. Peak total and free venous ropivacaine concentrations after 8？h and 16？h postoperative bolus injections were 2.6？μg/mL and 0.11？μg/mL, respectively. All concentrations observed were below the threshold for toxicity and no side effects were observed. Conclusion. Autotransfusion of patients undergoing knee or hip arthroplasty after local infiltration analgesia with 200？mg ropivacaine can be performed safely, even supplemented with 8？h and 16？h postoperative bolus injections. 1. Introduction Total knee and hip arthroplasty (TKA, THA) for osteoarthritis is still performed on broader indications even in elderly patients and in patients with previous or current medical conditions. In particular, comorbidity-like cardiovascular diseases and conditions with increased risk of bleeding or previous thromboembolic events are major challenges. The use of intravenous tranexamic acid (TA) prior to the procedure in THA and before release of the tourniquet in TKA has reduced the per- and postoperative bleeding about 50% [1, 2]. In order to further reduce the need for allogeneic blood, reinfusion of drainage blood is recommended in procedures with significant per- or postoperative bleeding, including TKA and THA. Because blood loss is relatively limited when using TA, reinfusion is generally not required in TKA and THA, but highly relevant in situations with increased risk of bleeding, including conditions with contraindications to TA. Intra- and periarticular local infiltration analgesia (LIA) have been introduced successfully in order to reduce postoperative pain and side effects to analgesics [3, 4]. Since drainage blood from arthroplasties treated with LIA might contain considerable amounts of the local analgesic drug, autologous blood
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