Surgical Local Infiltration of Analgesia (LIA) technique ONLY
| Weight | Total dose | Volume of 0.125% Levobupivacaine# + 1mg Adrenaline added to 200ml bag |
|---|---|---|
| >70kg | 150mg | 120ml |
| 55-69kg | 125mg | 100ml |
| 50-54kg | 100mg | 80ml |
| <50kg | 2mg/kg | TBC with anaesthetist |
# off-license use
Regional anaesthetic techniques (pre-op) + surgical LIA
| Weight | Anaesthetic dose | Surgical dose | Total dose |
|---|---|---|---|
| >70kg | 75mg (30ml of 0.25% bupivacaine) | 75mg (60mls of 0.125% levobupivacaine*) | 150mg |
| 55-69kg | 50mg (20 ml 0.25% bupivacaine diluted to 30mls with 0.9% NaCl) | 75mg (60mls of 0.125% levobupivacaine*) | 125mg |
| 50-54kg | 37.5mg (15ml 0.25% bupivacaine diluted to 30mls with 0.9% NaCl) | 75mg (60mls of 0.125% levobupivacaine*) | 112.5mg |
| <50kg | 37.5mg (15ml 0.25% bupivacaine diluted to 30mls with 0.9% NaCl) | TBC with anaesthetist | 2mg/kg |
Tip: Total volume of LA for blocks is always 30mls, suggest 25mls for PEricapsular Nerve Group (PENG) block and 5mls for Lateral Cutaneous Nerve of Thigh (LCN)
| Weight | Total dose | Volume of 0.125% Levobupivacaine + 1mg Adrenaline added to 200mls Bag |
|---|---|---|
| For weight >50kg | 75mg | 60ml |
Tip: Focus infiltration on posterior capsule and skin incision, especially deep layers of muscles
| Version | 2.0 |
| Guidelines Lead(s) | Drs Narayanan, Jadhav and Sundaram (Consultant anaesthetists) |
| Contributor(s) | |
| Lead Director / Chief of Service | Mr Luke Forster (Clinical Director Theatres and Critical Care) and Mr Rakesh Kucheria (Clinical Director Orthopaedics) |
| Library check completed | N/A |
| Ratified at | Anaesthetic Clinical Governance 23/09/26 |
| Date Issued | 30/09/2026 |
| Review Date | 30/09/2029 |
| Pharmaceutical dosing advice and formulary compliance checked by | Sophia Ahmad & Sheldon Cotta July 2026 |
| Key words | Joint Arthroplasty, GIRFT, THR, TKR, Knee replacement, Hip replacement |
This guideline has been registered with the Trust. However, clinical guidelines are guidelines only. The interpretation and application of clinical guidelines will remain the responsibility of the individual clinician. If in doubt, contact a senior colleague or expert. Caution is advised when using guidelines after the review date.
This guideline is for use in Frimley Health NHS Foundation Trust hospitals only. Any use outside this location will not be supported by the Trust and will be at the risk of the individual using it.
| Version | Date | Guideline Lead(s) | Status | Comment |
|---|---|---|---|---|
| 1.0 | November 2022 | Anaesthetic Consultant Orthopaedic Consultant | Final | Adapted from SWOAC protocol with kind permission of Dr Blandford 2022 Orthopaedic Clinical Governance 01/11/22 and Anaesthetic CG (sept 22). |
| 2.0 | Sept 2026 | Drs Narayanan, Jadhav and Sundaram (Consultant anaesthetists | Final | Update Ratified at Anaesthetic CG Sept 26 Reviewed by DTC 30/9/26 |
| Document Type | Document Name |
|---|---|
| GIRFT | Local Anaesthesia for Uni/Total Knee Replacement |
| GIRFT | TTA Prescription for Joint Arthroplasty Patients |
| GIRFT | Peri-operative plan for patients undergoing THR/TKR/UKR |