The efficacy and safety of epidural filter catheters when used for post-operative intra-articular anaesthesia

Abstract There are concerns about the risk of iatrogenic infection when employing local anaesthetic techniques with post-operative intra-articular infusions in total knee arthroplasty. This study aimed to determine the efficacy of intact epidural filters in preventing transit of bacteria and to deve...

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Bibliographic Details
Published in:	The knee Vol. 23; no. 1; pp. 133 - 136
Main Authors:	Reston, S.C, Basanagoudar, P, McNair, A.D, Deakin, A.H, Kinninmonth, A.W.G
Format:	Journal Article
Language:	English
Published:	Netherlands Elsevier B.V 01-01-2016 Elsevier Limited
Subjects:	Anesthesia, Local - instrumentation Anesthetics, Local - administration & dosage Arthralgia - etiology Arthralgia - therapy Arthroplasty, Replacement, Knee - adverse effects Automation Bacteria Bupivacaine - administration & dosage Catheters Confidence intervals Conflicts of interest Drinking water Epidural filters Experiments Filter rupture Humans Injections, Intra-Articular - instrumentation Joint surgery Local anaesthetic techniques Materials Testing Orthopedics Pain, Postoperative - etiology Pain, Postoperative - therapy Safety Local anaesthetic techniques Safety Filter rupture Epidural filters
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Summary:	Abstract There are concerns about the risk of iatrogenic infection when employing local anaesthetic techniques with post-operative intra-articular infusions in total knee arthroplasty. This study aimed to determine the efficacy of intact epidural filters in preventing transit of bacteria and to develop a technique of administration which would prevent membrane rupture. Filter efficacy was assessed using a standardised test suspension of Pseudomonas aeruginosa . Twenty millilitres of suspension was injected through isolated epidural filters ( n = 10) or filters with 40 cm of catheter tubing attached ( n = 30). For each filter, injections were carried out at 0, 8 and 24 h. Filtrates were collected, incubated, sub-cultured onto Columbia horse blood agar and examined for bacterial growth. Three delivery techniques were tested: manually controlled syringe with 5 ml of water at 20 ml/min, forced administration syringe with 5 ml of water at > 240 ml/min and an automated syringe driver delivering 40 ml of water at 6.7 ml/min. For the two techniques using syringes, three syringe sizes, 5 ml, 10 ml and 20 ml, were tested. Each test condition was carried out on 10 filters (total n = 70). Filters were examined for rupture. Intact epidural filters prevented bacterial transit in all cases. Manual controlled and automated syringe driver administration generated no filter ruptures. Manual forced administration generated 93% filter rupture. Ruptures occurred at peak pressures of approximately 620 kPa. Epidural filters can be used to prevent bacterial transit. These results suggest automated devices remove the risk of filter rupture. This study is relevant to all specialties that utilise these filters during infiltration such as epidurals or other regional anaesthetic techniques. Clinical relevance This study identified that filters are prone to rupture with high infusion rates and that manual techniques are particularly vulnerable. From these results, it is recommended that pumps are used to minimise risk of filter rupture.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0968-0160 1873-5800
DOI:	10.1016/j.knee.2015.01.012