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Third-Degree Heart Block Associated with Bupivacaine Infusion Following Total Knee ArthroplastyA Case Report
David C. Hay, MD1; Robert E. MayleJr., MD1; 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
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.
Investigation performed at the Department of Orthopaedic Surgery, Stanford University, Stanford, California

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 Sep 01;91(9):2238-2240. doi: 10.2106/JBJS.H.00723
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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.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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